Risk factors for extubation-related complications in morbidly obese patients undergoing bariatric surgery: a retrospective cohort study

Abstract

Background One-third of major anesthesia-related airway complications occur during or shortly after tracheal extubation. Obesity significantly impacts respiratory function and is a key contributor to morbidity and mortality. Patients with morbid obesity often require bariatric surgery. However, extubation-related complications in this specific surgical population have not been previously studied. This study aimed to determine the rate and frequency of complications during tracheal extubation in patients undergoing bariatric surgery and the associated risk factors for these complications.

Materials and methods This was a retrospective cohort study of adult patients above 18 years of age with a body mass index ≥ 40 kg/m2 who underwent bariatric surgery between June 2016 and June 2024. Extubation-related complications were defined as the occurrence of any of the following: vomiting, aspiration, laryngospasm, bronchospasm, cardiovascular instability, airway edema, desaturation (SpO2 < 90%), or the need for a rescue device or reintubation during or after tracheal extubation. Logistic regression analysis, adjusted for age and sex, was performed to evaluate the associations. The significance level was adjusted by applying the Bonferroni correction (0.05/16 = 0.0031), and a p-value < 0.0031 was interpreted as statistically significant.

Results Data from 1193 patients were analyzed. The overall complication rate was 4.4%, with the most frequent complication being desaturation, which occurred in 3.2% of patients. Logistic regression analysis showed that the odds of extubation-related complications increased twofold for obese patients with body mass index 50–59 kg/m2 (odds ratio [OR] 1.97, 95% confidence interval [95%CI] 0.99–3.94, p = 0.055) and threefold for patients with body mass index > 60 kg/m2 (OR 2.95, 95%CI 0.99–8.81, p = 0.05). The most commonly associated comorbidities were hypertension and obstructive sleep apnea, with an odds ratio of 2.98 for hypertension and 2.15 for obstructive sleep apnea (95%CI 1.40–6.33, p = 0.005; and 95%CI 1.08–4.29, p = 0.03; respectively). Despite these clinically important results, after applying the Bonferroni correction, none of these associations remain statistically significant, as the corrected p-values are above the threshold of p = 0.0031.

Conclusion This study identified desaturation as the most common complication post-extubation of morbidly obese patients who underwent bariatric surgery. Moreover, we found that the odds of extubation-related complications increased with increasing obesity classes, particularly in patients with body mass index 50–59 kg/m2 and > 60 kg/m2, as well as in patients with hypertension and obstructive sleep apnea. These findings suggest the importance of tailored extubation strategies and close perioperative monitoring in morbidly obese patients to mitigate extubation-related risks.