Outcome of bariatric surgical patients admitted to the ICU

Background

The problem of obesity has reached epidemic proportions and the number of bariatric procedures is increasing. There are few data regarding the outcome of these patients in the intensive care environment.

Objective

The aim of this study was to evaluate the outcome of bariatric surgical patients admitted to the ICU.

Setting

An eight-bed surgical ICU in a 50-bed private hospital.

Methods

From April 2003 to February 2005 we prospectively followed bariatric surgical patients admitted to the ICU. The outcome and ICU resource utilization were recorded. The APACHE II score was calculated (QuaTI System software database; Dixtal, SP, Brazil).

Results

There were 304 patients (240 female) in 313 consecutive ICU admissions. The mean age was 36.9 ± 10.9 years. The mean BMI was 44.10 ± 5.2 kg/m². Of these patients, 302 (99.3%) were admitted in the immediate postoperative period for a primary procedure. A total of 252 patients (82.9%) underwent Roux-en-Y gastric bypass (16 laparoscopic) and 52 patients (17.1%) underwent biliopancreatic diversion (two laparoscopic). In 20 (6.4%) of 313 admissions, the length of stay was >24 hours. The APACHE II score was 10.0 ± 9.2. The mean LOS was 7.8 ± 16.8 days. The main reasons for unplanned ICU admissions (n = 11) were bowel occlusion (n = 2), anastomotic leakage (n = 2), gastrointestinal bleeding (n = 2), wound infection (n = 1), pulmonary embolism (n = 1), acute pulmonary edema (n = 1), massive atelectasis (n = 1) and perforated bowel (n = 1). There was need for mechanical ventilation in 22 (7.0%) admissions, a pulmonary artery catheter in two (0.6%), dialysis therapy in one (0.3%) and parenteral nutrition in one (0.3%). Only three patients have developed complications (anaphylactic reaction, respiratory acidosis, cetoacidosis) during the immediate postoperative period for a primary procedure (<48 hours) and only one patient has never been discharged from the ICU. The 28-day ICU mortality rate was 0.65% (n = 2) and the overall ICU mortality rate was 0.98% (n = 3).

Conclusions

Based on these preliminary results, we conclude that bariatric surgical patients in the immediate postoperative period for a primary procedure are very low risk ICU patients.