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A4060
October 24, 2017
43032.375 - 43032.458333
Room Exhibit Hall B2 - Area B
Characteristics of Morbidly Obese Patients Receiving a Supraglottic Airway for Elective Surgery
Wejdan Battarjee, M.D., Ingrid Moreno-Duarte, M.D., Iwona Bonney, Ph.D., Roman Schumann, M.D.
Tufts Medical Center, Boston, Massachusetts, United States
Disclosures: W. Battarjee: None. I. Moreno-Duarte: None. I. Bonney: None. R. Schumann: Royalties; Self; UP-TO-DATE, WALTHAM, MA, USA.
Introduction: Supraglottic airway use has not been systematically investigated in morbidly obese patients. With the availability of 2nd and 3rd generation SGAs morbidly obese patients may be considered appropriate candidates for SGA use despite their potentially higher risk profile. We hypothesized that obese patients receiving an SGA have a higher co-morbidity composite and aspiration risk compared to non-obese patients for similar procedures.

Methods: Following IRB approval we reviewed the records of 870 patients undergoing elective procedures considered appropriate for SGA use in healthy non-obese patients. Patients were assessed for an 9-point co-morbidity composite (CMC, 0-8) excluding BMI and ASA status classification, a 4-point aspiration risk index (ARI, 0-3) and a 7-point airway abnormality score (AAS, 0-6). We compared the prevalence of SGA vs endotracheal tube (ETT) use for these procedures and the demographics for these 2 groups. We then categorized the study population into 3 BMI groups: I. <30, II. 30 - < 35 and III. ≥ 35 and examined their differences in CMC, ARI and AAS when receiving either an SGA or an ETT for similar procedures. We used an unpaired t-test or a chi square as appropriate for comparisons between the SGA and the ETT group. A one-way ANOVA was used for comparison between the 3 BMI groups for continuous dependent variables.

Results:
Demographic characteristics of the entire cohort including 145 ETT and 725 SGA patients are shown in Table 1. Patients in the ETT cohort had significantly higher CMC, ARI and AAS as well as procedure duration. Table 2 summarizes the differences for groups I-III within the SGA and ETT cohorts. Between groups obese patients receiving an SGA or ETT had higher CMC, ARI and AAS scores. In SGA patients, the odds of an additional comorbidity was 2.6 and 2.4 times higher for group II and III respectively (p<0.001), whereas in ETT patients these odds were 3.3 and 5.7 times higher (p<0.001). Group III patients receiving an ETT vs an SGA had a significantly higher CMC (p<0.002) and ARI (p<0.0012) but not AAS (p>0.05). The SGA exchange or conversion rate was very low at 1.84% (Fig. 1).

Discussion:
For procedures considered appropriate, SGA use was common in obese patients. As might be expected, obese patients receiving either an ETT or SGA had a significantly higher co-morbidity burden and airway abnormality score compared to patients with a BMI < 30. Morbidly obese patients (BMI > 35) receiving an ETT had a significantly higher aspiration risk index. There was a significantly increasing likelihood for having additional co-morbidities with increasing BMI, which was more pronounced for patients receiving an ETT than an SGA. An ETT is chosen in selected obese patients who have significantly greater co-morbidities, and aspiration risk than their obese counterparts receiving an SGA, indicating judicious practice.







Figure 1
Figure 2

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