A new study reports that patients who have metabolic syndrome prior to having bariatric surgery is more likely than other patients to have pulmonary complications post-op. A previous study from Tufts Medical Center in Boston found that 1% of patients experience postoperative pulmonary complications including atelectasis, pneumothorax and pneumonia. However the latest study was the first to connect that metabolic syndrome or MetS with these patients.
No other study has looked specifically at pulmonary complications and these patients. Previous ones have looked at mortality rates, but nothing that explained why specific complications occurred in certain patients and not others. This helps surgeons to better explain risks to specific patients and to reassure others who do not have metabolic syndromes the severe unlikeliness they will have these complications.
However, according to the researchers of the study also found that other comorbidities such as dyslipidemia, hypertension, glucose intolerance and obesity improve after bariatric surgery. The study however points out that the incidence of Metabolic syndrome with obese patients has not been studied as well as they’d like.
About the Study
The team looked at data from procedures occurring January 2008 to December 2010 and included different demographics, ASA statuses, procedural information and the presence of Mets-associated comorbidities before surgery. They analyzed 158,408 different bariatric surgery procedures, 52% were gastric bypass, 40% gastric banding and 4% gastric sleeve (sleeve gastrectomy). For the study, pulmonary complications included acute respiratory distress syndrome, respiratory failure, pneumothorax, pneumonia, atelectasis and pleural effusion.
The mean patient age for the study was 45.7 years with the oldest patient being 67.5 years old. 78.5% of patients were women. The majority of these patients had an ASA physical status of 3 (65.3% of those studied).
Metabolic syndrome was found in 12.7% of the patients or 20,158 patients. The study’s researchers found that those with MetS had more instances of pulmonary complications except in case of pneumothorax. Most of these patients had either respiratory failure or pneumonia after their weight loss surgery.
The study’s researchers aren’t sure if the presence of metabolic syndrome impairs the patient’s physiological status or if a combination of comorbidities are responsible for these things. They believe that optimized pre-planning should occur with these types of patients before committing to weight loss surgery.
Another study presented at the 2013 Postgraduate Assembly in Anesthesiology found that an obstructive sleep apnea diagnosis as well as being overweight predicted a patient’s particular odds of being transferred to a step-down unit post-op.
Other connection was found with patients who use continuous positive airway pressure machines. Studies found that increased pressure in the esophagus and stomach can lead to increased risk of complications, so these patients do not automatically connect back to their CPAP machines after surgery.
By taking time to understand these connections, patients can more safely be monitored for post-op complications and can be treated in such a way to prevent these ailments from occurring.