Outcomes Associated with Early Postoperative Noninvasive Ventilation in Bariatric Surgical Patients with Sleep Apnea.

Published online

Journal Article

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.

Full Text

Duke Authors

Cited Authors

  • Stefan, MS; Hill, NS; Raghunathan, K; Liu, X; Pekow, PS; Memtsoudis, SG; Ramachandran, SK; Lindenauer, PK

Published Date

  • November 15, 2016

Published In

Volume / Issue

  • 12 / 11

Start / End Page

  • 1507 - 1516

PubMed ID

  • 27568901

Pubmed Central ID

  • 27568901

Electronic International Standard Serial Number (EISSN)

  • 1550-9397

Digital Object Identifier (DOI)

  • 10.5664/jcsm.6278

Language

  • eng

Conference Location

  • United States