Are bariatric patients putting a strain on intensive care beds?

Introduction

This study looks at the characteristics and outcomes of patients admitted to an ICU after bariatric surgery and considers the staffing and financial implications for the National Health Service (NHS). There is currently increased government incentive to treat obese patients with bariatric surgery with the aim of reducing co-morbidities in the future.

Methods

A retrospective analysis of bariatric surgery patients requiring an ICU admission between 1 February 2007 and 31 August 2009. The study was carried out in a nine-bed mixed medical and surgical adult ICU providing level 2 and level 3 critical care to a 430-bed hospital in East London with a regional laparoscopic bariatric surgery service. Medical records were reviewed and information including gender, body mass index (BMI), age, reason for admission, treatment required and length of stay in the unit was collected. APACHE II and SOFA scores were calculated.

Results

A total of 502 bariatric operations were performed during this period. Twenty-four (4.8%) patients required ICU admission at a cost of £2,500 (€2,750) per day for an average of 8.7 days (range 1 to 48). The average length of stay for all elective admissions was 2 days and for emergency admissions was on average 10 days. Cumulatively, bariatric patients spent a total of 209 days on the unit costing £522,500 (€575,300). The average weight was 146 kg (range 71 to 320 kg). The average BMI was 53.3 (range 32.1 to 102.1). The age range was 24 to 69 (mean 48) with an average APACHE II score of 13 and average SOFA score of 5. Four admissions (17%) were elective, due to severe co-morbidities, extreme weight or anticipated airway difficulties. Seven patients needed to go back to theatre one or more times for re-exploratory surgery due to postoperative complications. Three patients remained intubated for 19 days or more, two of whom required a tracheostomy. Three patients died; two from intra-abdominal haemorrhage and one from sepsis.

Conclusions

This is a high-risk cohort of patients, with 4.8% requiring an ICU admission. The need for patients to return to theatre for re-exploratory surgery was associated with longer ICU stays and multiple complications. This demand on critical care services is likely to increase as bariatric surgery continues to grow as a specialty and the NHS will need to increase investment in ICUs accordingly.