Abstract
BackgroundConservative obesity treatment often leads to limited results. Bariatric surgery is highly efficient, but the candidates are at risk of developing perioperative complications. Bariatric outcomes have been well described in the past, but there are only few reports of perioperative outcomes.The aim of this study was to evaluate the incidence of anaesthetic and surgical complications of Roux-en-Y bypass.MethodsData of all adult patients, who underwent primary Roux-en-Y gastric bypass surgery between 1/2006 and 12/2013 at the University Hospital Zurich were analysed. Using our clinical database, anaesthetic and surgical complications during the first 30 days after surgery were analysed and risk factors determined by multivariate analysis.ResultsSeven hundred eleven patients (72% female, median age 40 years) were analysed. Overall, surgical complications occurred in 34% patient, while complications attributable to anaesthesia occurred in 37%. Post-operative nausea and vomiting (PONV) were observed in 34%, intubation-related complications in 4%, and delayed extubation in 2% of our patients. Within the first 30 days after surgery, 22% of the patients presented with an infection. Gastrointestinal complications were found in 8%, and bleeding complications in 3%. Anaesthesia complications were less common in older patients and in patients anaesthetized with a volatile anaesthetic. Severe complications were more common in patients with a lower body mass index (BMI) and with longer surgery. The risk to develop a postoperative infection was higher in diabetic patients.ConclusionRoux-en-Y bariatric surgery has few anaesthetic complications, the most common is PONV. PONV is more common in younger patients and not more common with volatile anaesthetics. Major complications are overall rare and occur in patients with lower BMI and longer surgery, likely reflecting more difficult procedures.
Highlights
Conservative obesity treatment often leads to limited results
Evaluation of predictors of anaesthesia complications We evaluated the impact of patient age, duration of surgery, body mass index (BMI), American Society of Anesthesiologists physical status classification (ASA) classification status, the type of anaesthesia, and catecholamine and Post-operative nausea and vomiting (PONV) prophylaxis on the occurrence of anaesthesia complications
* indicates significant factors with a p < 0.05 p-value 0.3 0.05 0.06 0.2 0.02*. In this retrospective cohort study, we found that approximately one third of patients undergoing Roux-en-Y gastric bypass (RYGB) surgery in a Swiss university hospital suffer from either an anaesthesia- or surgery-related perioperative complications
Summary
Conservative obesity treatment often leads to limited results. Bariatric surgery is highly efficient, but the candidates are at risk of developing perioperative complications. Obesity is a chronic and multifactorial disease with a disproportional increase in adipose tissue. It is graded into three classes: patients with a body mass index (BMI) of 30.0–34.9 kg/m2 are referred to as obese patients class I, BMI 35.0–39.9 kg/m2 as class II, BMI > 40 kg/m2 as class III [1]. Bariatric surgery is an effective treatment, which may reduce associated diseases such as diabetes mellitus type 2 (T2DM), dyslipidaemia or obstructive sleep apnoea (OSAS) [5,6,7,8,9,10,11,12,13,14] and even mortality rates of morbidly obese patients [7, 15]
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