Is fear for postoperative cardiopulmonary complications after bariatric surgery in patients with obstructive sleep apnea justified? A systematic review

Abstract

Background: To evaluate the influence of obstructive sleep apnea (OSA) on postoperative cardiopulmonary complications in bariatric surgery patients.

Methods: PubMed, Embase, and the Cochrane central register databases were searched. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement was used for reviewing.

Results: Thirteen studies were included (n = 98,935). OSA was documented in 36,368 (37%) patients. The cardiopulmonary complication rate varied between .0% and 25.8%; no clear association with OSA was found (rate .0% to 18%), possibly because of optimized situations such as continuous positive airway pressure. OSA appeared to be no independent risk factor for intensive care unit (ICU) admission, death, or longer length of stay in most studies.

Conclusions: Overall, presented data showed no clear association of OSA with cardiopulmonary morbidity, ICU admissions, mortality, and length of stay after bariatric surgery. Although this questions the justification of admitting OSA patients to the ICU, future studies are required investigating the effect of monitoring strategies and optimizing treatments including continuous positive airway pressure use.

Keywords: Bariatric surgery; Continuous positive airway pressure; Intensive care unit; Length of stay; Obstructive sleep apnea; Postoperative complications.