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Perioperative Incentive Spirometry and Postoperative Oxygenation after Bariatric Surgery: a Randomized Comparative
Tanu Shailendra Bandwar1, Amita Chandel2, Jyoti Raghuwanshi2
1Department of Anesthesiology, Government Medical College, Seoni, Madhya Pradesh, India.
Background:
Postoperative hypoxemia remains an important concern after laparoscopic bariatric surgery. This study evaluated a Perioperative incentive spirometry which means using an incentive spirometer before and/or after surgery to encourage the patient to take slow, deep breaths and fully expand the lungs that combined preoperative instruction and supervised practice with supervised postoperative assessments at 6, 12 and 24 hours and examined oxygenation together with respiratory-support and intensive care unit (ICU)-utilization outcomes.
Methods:
In this single-centre randomized comparative study, 180 adults aged 18-70 years with body mass index >40 kg/m² undergoing laparoscopic bariatric surgery were allocated to standard care without incentive spirometry (Group A, n=90) or perioperative incentive spirometry (Group B, n=90). Room-air peripheral oxygen saturation (SpO₂) was recorded preoperatively and at 6, 12 and 24 hours postoperatively. A composite respiratory-support endpoint (oxygen supplementation and/or bronchodilator use), duration of oxygen support, ICU stay, incentive-spirometry performance and pulmonary complications were assessed.
Results:
Baseline SpO₂ was higher in Group A than Group B (98.07±1.01% vs 97.08±1.15%, p=0.001), requiring cautious interpretation of postoperative comparisons. At six hours, SpO₂ was similar (mean difference Group B-Group A 0.22 percentage points, 95% CI -0.34 to 0.78; p=0.433). At 12 and 24 hours, SpO₂ was higher in Group B (0.59, 95% CI 0.08 to 1.10; p=0.024 and 1.10, 95% CI 0.70 to 1.50; p=0.001, respectively). The composite respiratory-support endpoint occurred in 47.8% of Group B versus 100% of Group A (RR 0.48, 95% CI 0.38-0.59; p=0.001). Oxygen-support duration and ICU stay were shorter in Group B by 2.44 hours (95% CI 1.11-3.77) and 4.66 hours (95% CI 1.45-7.87), respectively. Pulmonary complications were numerically lower in Group B than in Group A (2.2% vs 6.7%; RR 0.33, 95% CI 0.07-1.61; p=0.148).
Conclusion:
Perioperative incentive spirometry was associated with better later postoperative oxygenation and lower respiratory-support and ICU utilization. However, the significant baseline SpO₂ imbalance, use of a composite respiratory-support endpoint and non-significant pulmonary-complication result warrant cautious interpretation.