Critical care utilisation following bariatric surgery

Introduction

Following the introduction of a new bariatric surgical service in Sheffield, we aimed to assess the impact upon critical care services and examine how this has changed as the service has evolved.

Method

All admissions for bariatric surgery between 1 April 2003 and 30 April 2006 were reviewed retrospectively. These procedures were performed on two sites, the Royal Hallamshire Hospital (RHH) and Thornbury Hospital (TH). The critical care admissions and length of hospital stay (LOS) were reviewed.

Results

A total of 497 patients were identified as having had bariatric surgery. After review of hospital and critical care admission data, a total of 473 were identified with complete data. Of these, 94 (19.9%) were open procedures (OP), 260 (55.0%) laparoscopic bandings (LB) and 119 (25.1%) laparoscopic gastric bypasses (LGB). The age range was 16–68 years. The average hospital LOS for OP was 6.8 days, for LGB 4.0 days and for LB 1.9 days. Surgical procedures and HDU admissions increased annually (2003–2006) from 74 to 249, and 21 to 107, respectively. As a proportion, open procedures declined from 60% to 7%, and laparoscopic interventions increased (LB from 40% to 63% and LGB from 0% to 30%). There were a total of 14 admissions to the ITU by 10 patients, of which seven had undergone an initial OP. No admissions were elective and eight patients required further surgical interventions. HDU admissions occurred on both sites, with 148/277 (53.4%) of patients admitted to HDU at TH, and 53/196 (27.6%) at RHH. At TH only three patients required level 2 care, and 95 were discharged within 26 hours. At RHH, 16 patients required level 2 care, and 38 were discharged within 26 hours.

Discussion

The requirement for ITU admission in this surgical group is, and has remained, low, despite a significant increase in bariatric surgical procedures. This increase is predominantly laparoscopic surgery. HDU activity has increased as the service has expanded; however, 90.4% of this is level 1 care, particularly at TH, where admission to the HDU is a matter of policy rather than clinical necessity. Availability of a level 1 facility would significantly decrease the requirement for HDU provision – an important consideration when introducing a new bariatric service.