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The Effects of Perioperative Factors on Early Postoperative Morbidity in Bariatric Surgery

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Abstract

Purpose

This study aims to examine the predictive role of obesity-type-related indexes and perioperative intraabdominal pressure measurements for early postoperative complications following bariatric surgery.

Materials and Methods

Sixty-seven female patients with obesity who underwent bariatric surgery (laparoscopic sleeve gastrectomy or gastric bypass) were included in this study. Obesity-related indexes (BMI, waist/hip ratio, and waist/height ratio) were calculated using patient data. Intraoperative hemodynamic measurements and intraabdominal pressure measurements were done at the beginning and at the end of the operation. Intraabdominal pressure measurements were done using both bladder port and trocar port. Patients were followed for early postoperative complications.

Results

Among 67 patients included, 22 developed early postoperative complications (32.8%), mostly pulmonary (20.9%). Trans-trocar IAP measured at the beginning of the operation emerged as the single independent predictor of postoperative complications (OR, 40.3; p = 0.002). Based on ROC analysis, AUC for predicting complications was 0.955 (p < 0.01). Optimal cutoff point (≥ 14.5 mmHg) was associated with 100% sensitivity and 82% specificity. In addition, there were weak but significant positive correlations between trans-trocar IAP-beginning and BMI (r = 0.443, p < 0.001), waist/hip ratio (r = 0.434, p < 0.001), and waist/height ratio (r = 0.539, p < 0.001).

Conclusion

Findings of this study suggest that a high baseline intraabdominal pressure predicts a higher risk for early postoperative complications following bariatric surgery. This information would help improve patient care. Further large studies are warranted.

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Authors and Affiliations

  1. Department of Anesthesiology and Reanimation, School of Medicine, Marmara University, Istanbul, 34890, Turkey

    Seniyye Ulgen Zengin & Meliha Orhon Ergun

  2. Pendik Egitim ve Arastirma Hastanesi, Fevzi Cakmak Mah. Muhsin Yazicioglu Cad. No: 10, Ustkaynarca, Pendik, 34899, Istanbul, Turkey

    Seniyye Ulgen Zengin

  3. Department of General Surgery, School of Medicine, Marmara University, Istanbul, 34890, Turkey

    Omer Gunal

Authors
  1. Seniyye Ulgen Zengin
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  2. Meliha Orhon Ergun
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  3. Omer Gunal
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Corresponding author

Correspondence to Seniyye Ulgen Zengin.

Ethics declarations

Ethics Approval

All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Conflict of Interest

The authors declare no competing interests.

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Key Points

Obesity is associated with increased intraabdominal pressure.

Bariatric surgery may occasionally be associated with obesity-related complications.

Intraabdominal pressure predicts early postoperative complications.

This may aid in early identification of patients at risk and improve patient care.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (MP4 103040 KB) Supplementary video. Preparation of trocar site, placement of trocar, and trans trocar pressure measurement. The trocar entrance site is manually (digitally) checked by the surgeon to assure absence of obstruction. Trocar is placed and patency is checked with video image prior to the pressure measurements. Intraabdominal pressure measurement is made using pressure probe (arterial transducer)

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Zengin, S.U., Orhon Ergun, M. & Gunal, O. The Effects of Perioperative Factors on Early Postoperative Morbidity in Bariatric Surgery. OBES SURG 32, 1236–1242 (2022). https://doi.org/10.1007/s11695-022-05931-2

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  • DOI: https://doi.org/10.1007/s11695-022-05931-2

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