CHEST Guidelines-Postoperative-Complications-in-Obesity-Hypoventila

Postoperative-Complications-in-Obesity-Hypoventila

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The prevalence of obesity hypoventilation syndrome (OHS), characterized by obesity, daytime hypoventilation, and sleep-disordered breathing, is notable due to the global obesity epidemic, affecting up to 0.6% of the general population and significantly more among those with obstructive sleep apnea (OSA). OHS can heighten postoperative risks, notably when combined with OSA and hypercapnia, where CO2 levels exceed 45 mm Hg. Studies indicate that hypercapnic OSA is associated with increased postoperative complications such as respiratory failure and heart failure, which are not necessarily linked to higher mortality but do result in longer hospital stays.<br /><br />Kaw and colleagues provided evidence that concomitant hypercapnia with OSA presents a substantially increased risk of postoperative issues than OSA alone. This highlights the need for nuanced phenotyping beyond the apnea-hypopnea index (AHI), which aggregates the number of breathing interruptions per hour of sleep. Despite AHI being a widely used measure of OSA severity, it's heterogeneous and may not fully capture the patient’s risk profile. The study noted hypercapnia as the more significant predictor of postoperative complications rather than the severity of OSA measured by AHI.<br /><br />The research recommends a more comprehensive preoperative screening for OSA and OHS using tools like the STOP-Bang questionnaire and blood bicarbonate levels to better identify at-risk patients. Additionally, considering local or regional anesthesia might mitigate risks as per guidelines from the American Society of Anesthesiologists. The ongoing challenge lies in evolving strategies that align closely with patient-specific risk factors to optimize perioperative management and outcomes for those affected by these complex conditions.

Keywords

obesity hypoventilation syndrome

OHS

obstructive sleep apnea

OSA

hypercapnia

postoperative complications

apnea-hypopnea index

preoperative screening

STOP-Bang questionnaire

perioperative management