Peri-operative outcomes of bariatric surgery in obstructive sleep apnoea: a single-centre cohort study

The prevalence of obstructive sleep apnoea (OSA) is increasing worldwide. Bariatric surgery is an option where conventional measures to achieve weight loss fail. We compared peri-operative outcomes in patients living with obesity with and without OSA undergoing bariatric surgery.

Retrospective cohort study of consecutive patients undergoing bariatric surgery at a tertiary referral centre. Data were extracted from electronic patient records. Primary outcomes were the rate of peri-operative complications and level of respiratory support. Secondary outcomes were length of stay (LOS), and the highest level of care required.

A total of 302 patients underwent surgery [age 47 (±11.6) years, 238 (78.8%) female, body mass index (BMI) 48.1 (±7.8) kg/m²]. A total of 101 (33.4%) patients had moderate or severe OSA, or mild OSA with significant sleepiness, and were prescribed continuous positive airway pressure (CPAP), whilst 201 (66.6%) had mild OSA without symptoms or no OSA and weren't. Patients requiring CPAP were more obese (BMI 50.2 vs. 47.0 kg/m², P=0.002). Complications were analysed individually and according to the Clavien-Dindo classification. The incidence of each individual complication did not differ between groups. When grouped into Clavien-Dindo grades, only grade I complications differed: CPAP 9% vs. non-CPAP 2.6%, P=0.02). LOS was longer in the CPAP group [3 (1.5) vs. 2 (1.0) days, P=0.002].

The rate of peri-operative complications in patients with OSA undergoing bariatric surgery is low and can be addressed by the provision of CPAP therapy in most cases. However, a longer LOS and more frequent Grade I complications requires selection of appropriate post-operative monitoring.