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Rapid Weight Loss Is Associated with Preoperative Hypovolemia in Morbidly Obese Patients

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Abstract

Background

In morbidly obese patients (MO), adequate levels of venous return (VR) and left ventricular filling pressures (LVFP) are crucial in order to augment perioperative safety. Rapid weight loss (RWL) preparation with very low calorie diet is commonly used aiming to facilitate bariatric surgery. However, the impact of RWL on VR and LVFP is poorly studied.

Methods

In this prospective, controlled, single-center study, we hypothesized that RWL-prepared MO prior to bariatric surgery can be hypovolemic (i.e., low VR) and compared MO to lean controls with conventional overnight fasting. Twenty-eight morbidly obese patients were scheduled consecutively for bariatric surgery and 19 lean individuals (control group, CG) for elective general surgery. Preoperative assessment of VR, LVFP, and biventricular heart function was performed by a transthoracic echocardiography (TTE) protocol to all patients in the awake state. Assessment of VR and LVFP was made by inferior vena cava maximal diameter (IVCmax) and inferior vena cava collapsibility index- (IVCCI) derived right atrial pressure estimations.

Results

A majority of MO (71.4 %) were hypovolemic vs. 15.8 % of lean controls (p < 0.001, odds ratio = 13.3). IVCmax was shorter in MO than in CG (p < 0.001). IVCCI was higher in MO (62.1 ± 23 %) vs. controls (42.6 ± 20.8; p < 0.001). Even left atrium anterior–posterior diameter was shorter in MO compared to CG.

Conclusions

Preoperative RWL may induce hypovolemia in morbidly obese patients. Hypovolemia in MO was more common vs. lean controls. TTE is a rapid and feasible tool for assessment of preload even in morbid obesity.

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Acknowledgments

We are grateful to Göran Johansson for statistical assistance for this study. This research was supported by the Norrbotten County Council.

Conflict of interest

There are no conflicts of interest to disclose.

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Authors and Affiliations

  1. Department of Surgical and Perioperative Sciences, Umeå University, 90185, Umeå, Sweden

    Tomi Pösö, Doris Kesek, Roman Aroch & Ola Winsö

  2. Department of Cardiothoracic Anaesthesia, Heart Centre, Umeå University, Umeå, Sweden

    Doris Kesek

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  1. Tomi Pösö
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  2. Doris Kesek
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Correspondence to Tomi Pösö.

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Pösö, T., Kesek, D., Aroch, R. et al. Rapid Weight Loss Is Associated with Preoperative Hypovolemia in Morbidly Obese Patients. OBES SURG 23, 306–313 (2013). https://doi.org/10.1007/s11695-012-0790-1

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