The effect of postoperative weight loss on difficult intubation in bariatric surgery patients: a prospective...

Anatomical changes related to obesity-such as increased neck circumference, limited neck mobility, and excess soft tissue-may obstruct glottic visualization and increase the risk of difficult intubation. This study aims to evaluate whether weight loss following bariatric surgery leads to a measurable improvement in airway parameters, particularly the modified Cormack-Lehane (MCL) score.

In this prospective observational study, 129 patients undergoing bariatric surgery were included. Preoperative assessments included BMI, neck circumference, neck mobility, snoring score, modified Mallampati score (MMS), and MCL score. Postoperative reassessments were conducted at the 1st, 3rd, 6th, and 9th months. ROC curve analysis was performed to evaluate the predictive value of preoperative parameters for difficult intubation.

Neck mobility was found to be significantly associated with both difficult airway (p < 0.001) and difficult intubation (p = 0.000) based on univariate analysis. Significant reductions were observed in BMI, neck circumference, MMS, and MCL scores over the follow-up period (all p < 0.001). Difficult intubation incidence decreased from 10.9% at baseline to 2.3% at the 9th month. ROC analysis revealed that the preoperative modified Cormack-Lehane (MCL) score had the highest predictive value for difficult intubation, with an AUC of 0.975, sensitivity of 88.4%, and specificity of 84.6%.

Weight loss following bariatric surgery results in measurable improvement in airway classification scores and reduces the incidence of difficult intubation. These findings support the value of postoperative airway reassessment in obese patients prior to subsequent anesthetic procedures.