BS P03 Safety of Laparoscopic Cholecystectomy in patients with BMI > 35 kg/m2 without preoperative screening for Obstructive Sleep Apnoea

Abstract

Abstract Background Preoperative Obstructive Sleep Apnoea (OSA) screening, followed by sleep studies as indicated, is commonly performed for patients undergoing bariatric surgery in our hospital but not for patients with similar weight undergoing other surgeries such as laparoscopic cholecystectomy. The purpose of this audit was to understand if laparoscopic cholecystectomy can be performed safely in patients with a Body Mass Index (BMI) ≥35 kg/m2 without such screening. Methods Patients with a BMI ≥ 35 kg/m2 undergoing elective laparoscopic cholecystectomy between 2nd May 2014 and 4th April 2022 were included. Patients with known OSA were excluded and no patients were referred for sleep studies. Data on patient demographics, co-morbidities, and any intraoperative or postoperative surgical complications were extracted and analysed. Univariate associations between different preoperative and operative variables and 30-day morbidity were studied using the Fisher's exact test. Results A total of 434 patients were included in the audit (64 male, 370 female). The mean age was 49 +/- 15 years. The mean weight and BMI were 110 +/- 20 kg (range 70–79kg) and 37 +/- 6 kg/m2 respectively. The mean operating time was 70 +/- 31 minutes (median=62). Approximately, 92% (398/434) had a day case procedure. The readmission rate at 30-day was 1% (5/434). There were no intraoperative complications. 17 patients had post-operative complications including deep vein thrombosis (n=2), leak in transverse colon secondary to cholecysto-colic fistula (n=1), wound infection (n=9), bile leak and post-op ERCP (n=3), common bile duct stone requiring ERCP (n=1) and pneumonia (n=1). No patients required ITU or HDU admission for further organ support. The 30-day mortality rate was 0% (0/434) while the 30-day morbidity rate was 3.9% (17/434). ASA grade, previous abdominal surgery, hypertension, diabetes, dyslipidemia, smoking history, chronic obstructive pulmonary disease, ischemic heart disease, fatty liver disease, preoperative liver reducing diet, number of ports, and conversion to laparotomy were not associated with increased 30-day morbidity rate (p<0.05) on univariate analysis. Higher BMI values (≥40 and ≥50 kg/m2) were also not associated with increased 30-day morbidity rate (p<0.05). Conclusions This audit demonstrated that laparoscopic cholecystectomy can be performed safely without the need for preoperative sleep studies in patients with BMI ≥35 kg/m2.