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Abstract Introduction The coexistence of obstructive sleep apnea (OSA) and obesity creates an intricate clinical scenario, particularly for individuals pursuing bariatric surgery. OSA increases perioperative risks, including prolonged stay, re-intubation, and cardiovascular events. It is generally recommended that patients with OSA start using Positive Airway Pressure (PAP) therapy before surgery, however studies are mixed on whether use of PAP reduces postoperative or long-term complications, and many include only subjective compliance data. We examined objective pre-operative PAP use among OSA patients undergoing bariatric surgery and its impact in reducing post-operative complications. Methods Our study included data from 140 individuals who underwent bariatric surgery gathered over a 6-month period, with 79 having verified PAP use in the 30-days before surgery. A correlation analysis was conducted comparing 30-day pre-operative PAP use to total operative time, time in the Post-Anesthesia Care Unit (PACU), length of inpatient stay, collective PACU and inpatient time, ED visits within the 30 days post-op. There were no deaths, ICU transfers, respiratory or surgical complications in this sample. Furthermore, PAP use was categorized into tertiles, and an analysis of variances was completed for the following secondary variables: Apnea-Hypopnea Index (AHI), time with oxygen saturation 88% and 90%, age, and weight. Mean PAP use in minutes was 376±59 for the highest-use group, 183±61 for intermediate-use group, and 10±16 for lowest-use group. Results Our correlation analysis revealed no significant associations between 30-day pre-operative PAP use and above-mentioned outcomes. Upon PAP use stratification into tertiles, a statistically significant effect became apparent in relation to PACU time (p = 0.008), with oxygen saturation 88% as a significant covariate. The PACU time in minutes varied across tertiles, with the highest-use group having a PACU time of 169±106, the intermediate-use group with 217± 156s, and the lowest-use group with 202±129. Conclusion Overall, complications rates after bariatric surgery were low. Increased PAP use was significantly associated with shorter stays in the PACU, perhaps related to faster time to recovery from anesthesia due to lower number of desaturations, hence mitigating need for continued nursing monitoring which could potentially lower healthcare associated cost. Support (if any)
Bugazia et al. (Sat,) studied this question.