Mihaela S Stefan1,2,3, Nicholas S Hill4, Karthik Raghunathan5, Xiaoxia Liu1, Penelope S Pekow1,6, Stavros G Memtsoudis7, Satya Krishna Ramachandran8, Peter K Lindenauer1,2,3. 1. Center for Quality of Care Research, Baystate Medical Center, Springfield, MA. 2. Division of General Medicine, Baystate Medical Center, Springfield, MA. 3. Tufts University School of Medicine, Boston, MA. 4. Division of Pulmonary and Critical Care Medicine, Tufts University School of Medicine, Boston, MA. 5. Anesthesiology Service, Durham VA Medical Center, Duke University Medical Center, Durham, NC. 6. School of Public Health and Health Sciences, University of Massachusetts-Amherst, Amherst, MA. 7. Department of Anesthesiology, Hospital for Special Surgery, Weill Cornell Medical College of Cornell University, New York, NY. 8. Department of Anesthesiology, University of Michigan Health System, Ann Arbor, MI.
Abstract
STUDY OBJECTIVES: To examine the relationship of early initiation of noninvasive ventilation (NIV) with postoperative outcomes in patients with obstructive sleep apnea (OSA) undergoing bariatric surgery. METHODS: We included 5,266 patients with OSA undergoing bariatric surgeries at 161 hospitals in the United States. We defined early postoperative NIV as NIV used on the day of or the day after surgery; this could include prophylactic NIV or NIV used for early signs of respiratory deterioration. We developed a hierarchical model to identify factors associated with early use of NIV. Then, in a propensity matched cohort, we assessed the association between NIV use and outcomes. RESULTS: Overall, 996 patients (18.9%) were treated with early postoperative NIV. Predictors of NIV initiation were: male sex (odds ratio: 1.34, 95% confidence interval 1.14-1.59), older age, chronic obstructive pulmonary disease (COPD; odds ratio 1.39, confidence interval: 1.17-1.64), gastric bypass surgery, short-acting narcotics intravenous on the day of surgery and admission to a hospital with high rate of OSA diagnosis. In a propensity matched analysis, we found no significant association between early initiation of NIV and receipt of invasive mechanical ventilation (IMV) (early NIV 4.5% vs. no NIV 3.8% p = 0.46), cardiovascular complications or mortality. Results were consistent in several sensitivity analyses. CONCLUSIONS: In this large observational study of patients with OSA undergoing bariatric surgery, early postoperative NIV use was not associated with better outcomes including less intubation and mortality. Properly designed controlled trials will be necessary to provide more definitive answers to this important clinical question.
STUDY OBJECTIVES: To examine the relationship of early initiation of noninvasive ventilation (NIV) with postoperative outcomes in patients with obstructive sleep apnea (OSA) undergoing bariatric surgery. METHODS: We included 5,266 patients with OSA undergoing bariatric surgeries at 161 hospitals in the United States. We defined early postoperative NIV as NIV used on the day of or the day after surgery; this could include prophylactic NIV or NIV used for early signs of respiratory deterioration. We developed a hierarchical model to identify factors associated with early use of NIV. Then, in a propensity matched cohort, we assessed the association between NIV use and outcomes. RESULTS: Overall, 996 patients (18.9%) were treated with early postoperative NIV. Predictors of NIV initiation were: male sex (odds ratio: 1.34, 95% confidence interval 1.14-1.59), older age, chronic obstructive pulmonary disease (COPD; odds ratio 1.39, confidence interval: 1.17-1.64), gastric bypass surgery, short-acting narcotics intravenous on the day of surgery and admission to a hospital with high rate of OSA diagnosis. In a propensity matched analysis, we found no significant association between early initiation of NIV and receipt of invasive mechanical ventilation (IMV) (early NIV 4.5% vs. no NIV 3.8% p = 0.46), cardiovascular complications or mortality. Results were consistent in several sensitivity analyses. CONCLUSIONS: In this large observational study of patients with OSA undergoing bariatric surgery, early postoperative NIV use was not associated with better outcomes including less intubation and mortality. Properly designed controlled trials will be necessary to provide more definitive answers to this important clinical question.
Authors: Sebastian Zaremba; Christina H Shin; Matthew M Hutter; Sanjana A Malviya; Stephanie D Grabitz; Teresa MacDonald; Daniel Diaz-Gil; Satya Krishna Ramachandran; Dean Hess; Atul Malhotra; Matthias Eikermann Journal: Anesthesiology Date: 2016-07 Impact factor: 7.892
Authors: Daniel I McIsaac; Andrea Gershon; Duminda Wijeysundera; Gregory L Bryson; Neal Badner; Carl van Walraven Journal: Anesthesiology Date: 2015-08 Impact factor: 7.892