High mortality rate for patients requiring intensive care after surgical revision following bariatric surgery

Background To report the prognosis and management of patients reoperated for severe intraabdominal sepsis (IAS) after bariatric surgery (S0) and admitted to the surgical intensive care unit (ICU) for organ failure. Methods A French observational study in a 12-bed adult surgical intensive care unit in a 1,200-bed teaching hospital with expertise in bariatric surgery. From January 2001 to August 2006, 27 morbidly obese patients (18 transferred from other institutions) developed severe postoperative IAS (within 45 days). Clinical signs, biochemical and radiologic findings, and treatment during the postoperative course after S0 were reviewed. Time to reoperation, characteristics of IAS, demographic data, and disease severity scores at ICU admission were recorded and their influence on prognosis was analyzed. Results The presence of respiratory signs after S0 led to an incorrect diagnosis in more than 50% of the patients. Preoperative weight (body mass index [BMI]>50 kg/m(2)) and multiple reoperations were associated with a poorer prognosis in the ICU. The ICU mortality rate was 33% and increased with the number of organ failures at reoperation. Conclusion During the initial postoperative course after bariatric surgery, physical examination of the abdomen is unreliable to identify surgical complications. The presence of respiratory signs should prompt abdominal investigations before the onset of organ failure. An urgent laparoscopy, as soon as abnormal clinical events are detected, is a valuable tool for early diagnosis and could shorten the delay in treatment.