Background/Objectives: CPAP is utilized to prevent apneic arrest and/or hypoxia for sleep apnea patients. This modality has not been universally accepted for patients following upper intestinal surgery secondary to concerns that pressurized air will inflate the stomach and intestine resulting in anastomotic disruption. This study was performed to assess the safety and efficacy of postoperative CPAP for patients undergoing gastrojejunostomy as part of a gastric bypass procedure.
METHODS: Between December 1993 and December 1999, 548 obese patients were prospectively evaluated for complications of gastric bypass procedures. Patients with sleep apnea who required CPAP had the device placed immediately following surgery and continued to use CPAP throughout their hospitalization. Pressure settings were the same as used at home. Major complications were reviewed and catalogued by the hospital QA coordinator. Contingency table analysis was used to determine if CPAP contributed to the incidence of anastomotic leak.
RESULTS: Of the 548 patients undergoing gastric bypass 224 had obstructive sleep apnea requiring CPAP. There were 6 major anastomotic leaks, 3 of which occurred in CPAP treated patients. Contingency table analysis revealed no statistically significant effect of CPAP use and the incidence of major anastomotic leakage. There were 19 major complications in this series of patients, 5 were pulmonary emboli. Notably, there were no pneumonia complications.
CONCLUSIONS: Despite the theoretical risk of anastomotic injury from pressurized air delivered by CPAP no anastomotic leaks attributable to CPAP occurred. There were no major pulmonary complications such as pneumonia. CPAP is a useful modality for treating patients at risk for apnea following surgery. High gastric anastomoses that potentially are at risk for injury from CPAP are unaffected by it.
Contingency Table Analysis For CPAP
CPAP-No CPAP-Yes Total Leak
Leak-No 321 221 542
Leak-Yes 3 3 6
Total CPAP 324 224 n=548, p=0.648