Chapter 21 - Critical Care After Bariatric Surgery

Abstract

There is an epidemic of obesity, and patients having bariatric surgery are a major subgroup of the morbidly obese. Despite the significant comorbidities in this cohort (see below), the 30-day mortality rate after elective bariatric surgery is low (0.3%). Most obese patients without medical comorbidities who have an uncomplicated course after bariatric surgery are managed on the standard inpatient postoperative surgical unit. Estimation of an individual patient’s risk of postoperative complications is made by the patient’s anesthetist and surgeon during their preoperative assessments. These assessments determine the need for a planned postoperative admission to the intensive care unit (ICU) after elective bariatric surgery. Common complications that occur after bariatric surgery are related to the surgical wound, deep vein thrombosis, thromboembolism, revision surgery, or prolonged length of hospital stay. Although many of these complications can be managed on the standard inpatient surgical ward, some (e.g., emergency revision surgery) require unplanned admission to the ICU. As the prevalence of obesity is increasing, intensivists are more frequently confronted with obese patients in their daily practices. The principles of the postoperative management of the complicated patient after bariatric surgery described in this chapter can be applied to any obese patient who develops complications after any elective surgery, and vice versa.