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Outcomes Associated with Early Postoperative Noninvasive Ventilation in Bariatric Surgical Patients with Sleep Apnea

Mihaela S Stefan1,2,3, Nicholas S Hill4, Karthik Raghunathan5

  • 1Center for Quality of Care Research, Baystate Medical Center, Springfield, MA.

Journal of Clinical Sleep Medicine : JCSM : Official Publication of the American Academy of Sleep Medicine
|August 30, 2016
PubMed

Insights

Early noninvasive ventilation (NIV) in obstructive sleep apnea (OSA) patients after bariatric surgery did not improve outcomes like intubation or mortality. Further controlled trials are needed to confirm these findings for OSA patients.

Area of Science:

  • Critical Care Medicine
  • Sleep Medicine
  • Bariatric Surgery Outcomes

Background:

  • Obstructive sleep apnea (OSA) is common in patients undergoing bariatric surgery.
  • Postoperative respiratory complications are a concern in this patient population.
  • Noninvasive ventilation (NIV) is sometimes used to manage respiratory issues.

Purpose of the Study:

  • To investigate the association between early initiation of noninvasive ventilation (NIV) and postoperative outcomes.
  • To identify factors predicting early NIV use in patients with OSA undergoing bariatric surgery.

Main Methods:

  • A large observational study included 5,266 patients with OSA from 161 US hospitals.
  • Early postoperative NIV was defined as use on the day of or day after surgery.
  • Propensity score matching was used to compare outcomes between NIV and no-NIV groups.

Main Results:

  • Nearly 19% of patients received early NIV.
  • Predictors for NIV included male sex, older age, COPD, gastric bypass, narcotics, and high OSA diagnosis rates.
  • Early NIV initiation was not significantly associated with reduced invasive mechanical ventilation, cardiovascular complications, or mortality.

Conclusions:

  • Early postoperative NIV in OSA patients undergoing bariatric surgery showed no significant benefit in reducing intubation or mortality.
  • Further high-quality, randomized controlled trials are required to definitively answer the clinical question regarding NIV efficacy.
Abstract

Keywords:
continuous positive pressure ventilationgeneral surgeryoutcome researchsleep disorders

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