A peer-reviewed, evidence-based journal that promotes clinical development and metabolic insights in total bariatric patient care for the healthcare professional
Issue link: https://bariatrictimes.epubxp.com/i/651228
20 Anesthetic Aspects of Bariatric Surgery Bariatric Times • March 2016 o riginated from North America followed by Europe and Australasia (Figure 3). Clinical outcomes were explored in 28 percent (IARS) and 33 percent (ASA) of the abstracts, and topics included difficult airway a nd ventilation, difficult extubation, obstructive sleep apnea, pain control, surgical times, hospital length of stay, morbidity andmortality, and functional outcomes on discharge (Figure 4). Only six studies (IARS:2; A SA:4) explored the economic burden of obesity. The distribution of the study design categories was similar between societies (Figure 5). In the PubMed repository, bariatric surgery p ublications had an exponential increase (from 60 annually to 1,100 annually in 2014), whereas anesthesiology related articles (34 annually to 140 annually) and perioperative obesity articles (21 annually to 182 annually) h ad a modest growth (Figure 1). DISCUSSION Every year, an increasing number of patients with morbid obesity undergo surgery and a nesthesia. Patients with obesity often present a higher perioperative risk compared to their non-obese counterparts, 5 and pose a special challenge for the anesthesiologist as well as the perioperative care team. These patients require a detailed evaluation of their airway, cardiopulmonary, and endocrine status. Considering the complexity and increasing prevalence of these patients within the surgical population, our study surprisingly shows modest growth in research interest within the anesthesiology community over the past 14 years. This is in contrast to bariatric surgery publications tracked in PubMed, which had an exponential growth during the same period. Evidence-based perioperative anesthesia care recommendations for patients with obesity and morbid obesity are nascent and better developed for standardized surgical environments, such as bariatric surgery. Our exploration demonstrated an unmet need for anesthesiology to embrace perioperative care research for patients with obesity. In addition, thoughtful, prospective, high-quality studies are needed to further understand and improve care to these patients. CONCLUSION Despite a prevalence of perioperative obesity of approximately 30 percent, an average of just above two percent of scientific abstracts at the IARS and ASA were obesity related in the last 14 years. The relative number has increased annually for the ASA meeting only. The clinical outcomes studied reflect clinicians' concerns with obesity. More prospective, randomized, controlled and basic science studies are needed. Obesity-related articles concerning perioperative and anesthesia care in PubMed have increased modestly compared to surgical obesity-related literature, indicating that obesity focused research in anesthesiology is an unmet need. The exponential rise in bariatric surgical manuscripts alone during the same period likely mirrors bariatric surgical growth and evolution in techniques, possibly providing more attractive research targets for the surgical specialty within this population compared to anesthesiology concerns. Further Figure 1. Obesity-related publications from 2000 to 2 014. Annual n umber of scientific obesity- related abstracts (IARS, ASA), and obesity-related publications in PubMed (perioperative c are, anesthesia and obesity, bariatric surgery) Figure 2. Annual percentage of obesity abstracts compared to total s ubmissions. Specific annual distribution of anesthesia obesity-related abstracts for ASA and IARS over a 15- and 12-year period, r espectively Figure 3. O besity abstracts from 2000 to 2014 by country of origin. Figure 4. Obesity abstracts from 2000 to 2014 by main research topic. Figure 5. Study design of obesity research abstracts from 2000 to 2014