Safety of Continuous Postoperative Pulse Oximetry Monitoring Without Obstructive Sleep Apnea Screening in > 5000 Patients Undergoing Bariatric Surgery

Introduction: Obstructive sleep apnea (OSA) is common but often undiagnosed in obese patients undergoing bariatric surgery, and is associated with increased risk of cardiopulmonary complications. The aim of this study is to evaluate the safety of continuous postoperative pulse oximetry (CPOX) without preoperative OSA screening in bariatric patients. Methods: Retrospective, single-center cohort study of all consecutive patients who underwent bariatric surgery between 2011 and 2017. All patients were postoperatively monitored with CPOX and received oxygen supplementation. Patients with no history of OSA (the “CPOX” only group) were compared with patients with adequately treated OSA as a reference group. The primary outcome was the incidence of cardiopulmonary complications within 30 days after surgery. Secondary outcomes included overall 30-day complications, mortality, intensive care unit (ICU) admissions, readmissions, and length of stay. Results: In total, 5682 patients were included, 89.6% (n = 5089) had no history of OSA, 10.4% (n = 593) had adequately treated OSA. Cardiopulmonary complications occurred in the CPOX group and OSA group in 0.6% (n = 31) and 0.8% (n = 5), respectively (p = 0.171). No mortality occurred due to cardiopulmonary complications. In both groups, one patient required ICU admission for respiratory failure (p = 0.198). Non-cardiopulmonary complications occurred in 6.4% in the CPOX group and 7.8% in the OSA group (p = 0.792). Mortality, ICU admissions, readmissions, and length of stay were not significantly different between groups. Conclusions: These data suggest that CPOX monitoring without preoperative OSA screening is a safe and effective strategy in perioperative care of bariatric patients. Future studies are needed to assess whether this strategy is also cost-effective.