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

Publication ,  Journal Article
Stefan, MS; Hill, NS; Raghunathan, K; Liu, X; Pekow, PS; Memtsoudis, SG; Ramachandran, SK; Lindenauer, PK
Published in: J Clin Sleep Med
November 15, 2016

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.

Duke Scholars

Published In

J Clin Sleep Med

DOI

EISSN

1550-9397

Publication Date

November 15, 2016

Volume

12

Issue

11

Start / End Page

1507 / 1516

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Sleep Apnea, Obstructive
  • Retrospective Studies
  • Postoperative Complications
  • Noninvasive Ventilation
  • Neurology & Neurosurgery
  • Middle Aged
  • Male
  • Humans
  • Female
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Stefan, M. S., Hill, N. S., Raghunathan, K., Liu, X., Pekow, P. S., Memtsoudis, S. G., … Lindenauer, P. K. (2016). Outcomes Associated with Early Postoperative Noninvasive Ventilation in Bariatric Surgical Patients with Sleep Apnea. J Clin Sleep Med, 12(11), 1507–1516. https://doi.org/10.5664/jcsm.6278
Stefan, Mihaela S., Nicholas S. Hill, Karthik Raghunathan, Xiaoxia Liu, Penelope S. Pekow, Stavros G. Memtsoudis, Satya Krishna Ramachandran, and Peter K. Lindenauer. “Outcomes Associated with Early Postoperative Noninvasive Ventilation in Bariatric Surgical Patients with Sleep Apnea.J Clin Sleep Med 12, no. 11 (November 15, 2016): 1507–16. https://doi.org/10.5664/jcsm.6278.
Stefan MS, Hill NS, Raghunathan K, Liu X, Pekow PS, Memtsoudis SG, et al. Outcomes Associated with Early Postoperative Noninvasive Ventilation in Bariatric Surgical Patients with Sleep Apnea. J Clin Sleep Med. 2016 Nov 15;12(11):1507–16.
Stefan, Mihaela S., et al. “Outcomes Associated with Early Postoperative Noninvasive Ventilation in Bariatric Surgical Patients with Sleep Apnea.J Clin Sleep Med, vol. 12, no. 11, Nov. 2016, pp. 1507–16. Pubmed, doi:10.5664/jcsm.6278.
Stefan MS, Hill NS, Raghunathan K, Liu X, Pekow PS, Memtsoudis SG, Ramachandran SK, Lindenauer PK. Outcomes Associated with Early Postoperative Noninvasive Ventilation in Bariatric Surgical Patients with Sleep Apnea. J Clin Sleep Med. 2016 Nov 15;12(11):1507–1516.

Published In

J Clin Sleep Med

DOI

EISSN

1550-9397

Publication Date

November 15, 2016

Volume

12

Issue

11

Start / End Page

1507 / 1516

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Sleep Apnea, Obstructive
  • Retrospective Studies
  • Postoperative Complications
  • Noninvasive Ventilation
  • Neurology & Neurosurgery
  • Middle Aged
  • Male
  • Humans
  • Female