Froylich Dvir, Corcelles Ricard, Davis Matthew, Boules Mena, Daigle Christopher R, Schauer Philip R, Brethauer Stacy A
Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio.
Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio; Fundació Clínic per la Recerca Biomèdica. Hospital Clínic of Barcelona, Universitat de Barcelona, Barcelona, Spain.
Surg Obes Relat Dis. 2016 Aug;12(7):1391-1396. doi: 10.1016/j.soard.2015.11.031. Epub 2015 Dec 2.
Although uncommon, admission to the intensive care unit (ICU) after bariatric surgery may be necessary. This study evaluates characteristics of bariatric surgery patients that are admitted to the ICU, and identifies possible risk factors for increased ICU length of stay (LOS).
Academic hospital, United States.
A retrospective review of all ICU admissions after bariatric surgery from 2006 to 2013 was performed. Demographic characteristics and perioperative data were extracted, and risk factors for the LOS and mortality in the ICU were analyzed.
In total, 124 out of 4398 (2.8%) patients were admitted to the ICU after bariatric surgery. The mean age of these patients was 52.7±11.8 years and included 79 female patients (64%). There were 19 nonemergent or planned admissions (15.3%) and 105 unplanned admissions (84.7%). Mean body mass index was 47.8±12.2 kg/m, and mean American Society of Anesthesiology (ASA) score was 3.1±0.6. Roux-en-Y gastric bypass, sleeve gastrectomy, and adjustable gastric banding were performed in 80 (65%), 18 (15%), and 6 (5%) patients, respectively. Revisional procedures were performed in 15 (12%) patients. Respiratory failure was the most common cause for admission, occurring in 35 (28.2%) patients. The most common surgical complications requiring ICU admission were bleeding (n = 27) and anastomotic leak (n = 21). Mean ICU LOS was 6.0±9.6 (1-65) days. Mortality occurred in 5 (4.0%) patients. Based on univariate analysis, risk factors associated with ICU LOS were conversion from laparoscopic to open approach, anastomotic leak, time from operation to ICU admission, and reoperation. Higher ASA score was a significant risk factor for mortality.
ICU admission after bariatric surgery is uncommon but is associated with a significantly increased mortality. Anastomotic leak, conversions, time from operation to ICU admission, and reoperation have the greatest impact in determining the LOS in the ICU after bariatric surgery.
尽管不常见，但减肥手术后入住重症监护病房（ICU）可能是必要的。本研究评估了入住ICU的减肥手术患者的特征，并确定了ICU住院时间（LOS）增加的可能危险因素。
美国学术医院。
对2006年至2013年减肥手术后所有入住ICU的患者进行回顾性研究。提取人口统计学特征和围手术期数据，并分析ICU住院时间和死亡率的危险因素。
在4398例患者中，共有124例（2.8%）在减肥手术后入住ICU。这些患者的平均年龄为52.7±11.8岁，其中包括79例女性患者（64%）。有19例非急诊或计划内入院（15.3%）和105例非计划内入院（84.7%）。平均体重指数为47.8±12.2kg/m²，平均美国麻醉医师协会（ASA）评分为3.1±0.6。分别有80例（65%）、18例（15%）和6例（5%）患者接受了Roux-en-Y胃旁路术、袖状胃切除术和可调节胃束带术。15例（12%）患者进行了翻修手术。呼吸衰竭是最常见的入院原因，发生在35例（28.2%）患者中。需要入住ICU的最常见手术并发症是出血（n = 27）和吻合口漏（n = 21）。ICU平均住院时间为6.0±9.6（1 - 65）天。5例（4.0%）患者死亡。单因素分析显示，与ICU住院时间相关的危险因素包括从腹腔镜手术转为开放手术、吻合口漏、手术至入住ICU的时间以及再次手术。较高的ASA评分是死亡的显著危险因素。
减肥手术后入住ICU并不常见，但与死亡率显著增加相关。吻合口漏、手术方式转换、手术至入住ICU的时间以及再次手术对减肥手术后ICU住院时间的影响最大。
