ICU Needs for Bariatric ProgramsThursday, June 11, 2009
Modern laparoscopic bariatric surgery is generally safe and highly effective. Nevertheless, surgery is surgery and severely obese patients are complicated.
So it is both expected and probable that despite the best patient selection process and highly skilled surgical teams, things may go wrong resulting in the need for intensive care units (ICU) or in some case even death.
So how often do bariatric patients need ICU care?
This question was recently studied by Renee van den Broek and colleagues from Catharina Hospital, Eindhoven, the Netherlands, in a paper published in OBESITY SURGERY.
In this review of 265 bariatric surgery (mainly gastroplasties and Roux-en-Y gastric bypasses) procedures conducted from 2003 until 2006 in a tertiary level, mixed medical and surgical, adult ICU of a large referral hospital.
Twenty-two (8%) were admitted to the ICU, of which 14 (64%) were on an elective basis and eight (36%) emergently. Hospital length of stay (LOS) for all patients was 4.5 days and ICU LOS was 12 days. Notably, two outliers had a hospital length of stay of 59 and 77 days, respectively.
Most elective admissions were standard procedure because of obstructive sleep apnea (OSA) or super obesity, with a median ICU stay of 1 day.
Emergent admissions were mainly done after emergent surgery due to surgical complications and had a median ICU stay of 8 days.
There were no deaths during ICU stay.
In the total study population, the majority is female, while men dominate in the ICU-admitted group. Apparently, male sex is a risk factor for ICU admission after bariatric surgery.
Based on these findings, the authors estimate that 32 ICU days are needed per 100 diverse bariatric procedures. As these statistics include a substantial number of patients, who had open rather than laparoscopic surgery, these numbers are likely an overestimate.
Nevertheless, it is important to note that the vast majority of bariatric patients (~90%) do not need to be admitted to an ICU at all and of those who do, most patients are admitted to the ICU for only a few days with the majority of admissions planned.
The bottom line: as bariatric programs ramp up their numbers across the country, ICU’s must be available to bear the additional capacity required by these increased numbers of surgeries – although these numbers may be far smaller than you would expect with this patient population.