Influence of continuous positive airway pressure on postoperative leakage in bariatric surgery

Christel A.L. de Raaff, Marianne C. Kalff, Usha K. Coblijn, Claire E.E. de Vries, Nico de Vries, H. Jaap Bonjer, Bart A. van Wagensveld

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Background: Obstructive sleep apnea (OSA) affects two third of morbidly obese individuals undergoing bariatric surgery. Perioperative usage of continuous positive airway pressure (CPAP) is advised for moderately and severe OSA to avoid respiratory failure and cardiac events. CPAP increases the air pressure in the upper airway, but also may elevate the air pressure in the esophagus and stomach. Concern exists that this predisposes to mechanical stress resulting in suture or staple line disruption (further referred to as suture line disruption). Objectives: To evaluate whether perioperative CPAP usage is associated with an increased risk of suture line disruption after bariatric surgery. Setting: Obesity Center Amsterdam, OLVG-west, Amsterdam, the Netherlands. Methods: All patients who underwent bariatric surgery including a suture line were eligible for inclusion. Only patients with information regarding OSA severity as defined by the apnea-hypopnea-index and postoperative CPAP usage were included. Results: From November 2007 to August 2016, postoperative CPAP status was documented in 2135 patients: 497 (23.3%) used CPAP postoperatively, whereas 1638 (76.7%) used no CPAP. Mean body mass index was 44.1 kg/m2 (standard deviation 6.6). Suture line disruption occurred in 25 patients (1.2%). The leakage rate was not associated with CPAP usage (8 [1.6%] in CPAP group versus 17 [1%] in non-CPAP group, P = .300). CPAP was no risk factor for suture line disruption in multivariable analysis as well. Conclusion: Postoperative CPAP does not appear to increase the risk of suture line disruption in bariatric surgery. CPAP is recommended in all patients with moderate or severe OSA who undergo bariatric surgery.

Original languageEnglish
Pages (from-to)186-190
Number of pages5
JournalSurgery for Obesity and Related Diseases
Volume14
Issue number2
DOIs
Publication statusPublished - 1 Feb 2018

Cite this

de Raaff, Christel A.L. ; Kalff, Marianne C. ; Coblijn, Usha K. ; de Vries, Claire E.E. ; de Vries, Nico ; Bonjer, H. Jaap ; van Wagensveld, Bart A. / Influence of continuous positive airway pressure on postoperative leakage in bariatric surgery. In: Surgery for Obesity and Related Diseases. 2018 ; Vol. 14, No. 2. pp. 186-190.
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title = "Influence of continuous positive airway pressure on postoperative leakage in bariatric surgery",
abstract = "Background: Obstructive sleep apnea (OSA) affects two third of morbidly obese individuals undergoing bariatric surgery. Perioperative usage of continuous positive airway pressure (CPAP) is advised for moderately and severe OSA to avoid respiratory failure and cardiac events. CPAP increases the air pressure in the upper airway, but also may elevate the air pressure in the esophagus and stomach. Concern exists that this predisposes to mechanical stress resulting in suture or staple line disruption (further referred to as suture line disruption). Objectives: To evaluate whether perioperative CPAP usage is associated with an increased risk of suture line disruption after bariatric surgery. Setting: Obesity Center Amsterdam, OLVG-west, Amsterdam, the Netherlands. Methods: All patients who underwent bariatric surgery including a suture line were eligible for inclusion. Only patients with information regarding OSA severity as defined by the apnea-hypopnea-index and postoperative CPAP usage were included. Results: From November 2007 to August 2016, postoperative CPAP status was documented in 2135 patients: 497 (23.3{\%}) used CPAP postoperatively, whereas 1638 (76.7{\%}) used no CPAP. Mean body mass index was 44.1 kg/m2 (standard deviation 6.6). Suture line disruption occurred in 25 patients (1.2{\%}). The leakage rate was not associated with CPAP usage (8 [1.6{\%}] in CPAP group versus 17 [1{\%}] in non-CPAP group, P = .300). CPAP was no risk factor for suture line disruption in multivariable analysis as well. Conclusion: Postoperative CPAP does not appear to increase the risk of suture line disruption in bariatric surgery. CPAP is recommended in all patients with moderate or severe OSA who undergo bariatric surgery.",
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Influence of continuous positive airway pressure on postoperative leakage in bariatric surgery. / de Raaff, Christel A.L.; Kalff, Marianne C.; Coblijn, Usha K.; de Vries, Claire E.E.; de Vries, Nico; Bonjer, H. Jaap; van Wagensveld, Bart A.

In: Surgery for Obesity and Related Diseases, Vol. 14, No. 2, 01.02.2018, p. 186-190.

Research output: Contribution to journalArticleAcademicpeer-review

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AB - Background: Obstructive sleep apnea (OSA) affects two third of morbidly obese individuals undergoing bariatric surgery. Perioperative usage of continuous positive airway pressure (CPAP) is advised for moderately and severe OSA to avoid respiratory failure and cardiac events. CPAP increases the air pressure in the upper airway, but also may elevate the air pressure in the esophagus and stomach. Concern exists that this predisposes to mechanical stress resulting in suture or staple line disruption (further referred to as suture line disruption). Objectives: To evaluate whether perioperative CPAP usage is associated with an increased risk of suture line disruption after bariatric surgery. Setting: Obesity Center Amsterdam, OLVG-west, Amsterdam, the Netherlands. Methods: All patients who underwent bariatric surgery including a suture line were eligible for inclusion. Only patients with information regarding OSA severity as defined by the apnea-hypopnea-index and postoperative CPAP usage were included. Results: From November 2007 to August 2016, postoperative CPAP status was documented in 2135 patients: 497 (23.3%) used CPAP postoperatively, whereas 1638 (76.7%) used no CPAP. Mean body mass index was 44.1 kg/m2 (standard deviation 6.6). Suture line disruption occurred in 25 patients (1.2%). The leakage rate was not associated with CPAP usage (8 [1.6%] in CPAP group versus 17 [1%] in non-CPAP group, P = .300). CPAP was no risk factor for suture line disruption in multivariable analysis as well. Conclusion: Postoperative CPAP does not appear to increase the risk of suture line disruption in bariatric surgery. CPAP is recommended in all patients with moderate or severe OSA who undergo bariatric surgery.

KW - Bariatric surgery

KW - Continuous positive airway pressure

KW - Obstructive sleep apnea

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