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The effect of class 3 obesity on the functionality of supraglottic airway devices: a historical cohort analysis with propensity score matching

L’effet de l’obésité de classe 3 sur la fonctionnalité des dispositifs supraglottiques : une analyse de cohorte historique avec appariement par score de propension

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Canadian Journal of Anesthesia/Journal canadien d'anesthésie Aims and scope Submit manuscript

Abstract

Purpose

Supraglottic airway devices (SGAs) have been increasingly used as a primary airway in patients undergoing anesthesia as an alternative to endotracheal tubes. Second-generation devices have expanded their applicability to include uses in patients with obesity. Nevertheless, there is limited evidence of SGA suitability for patients with class 3 obesity (body mass index [BMI] ≥ 40 kg·m–2). As such, we compared rates of SGA functionality between patients with class 3 obesity and patients without class 3 obesity undergoing general anesthesia.

Methods

We performed a propensity score matching analysis using inverse probability of treatment weighting to compare the functionality of SGAs in adult patients with class 3 obesity vs without class 3 obesity. These patients underwent surgery at a hospital in Queensland, Australia from November 2017 to September 2020 and had a SGA inserted as part of their anesthetic care. All data were collected from patients’ electronic medical records. We included 321 patients in the cohort with class 3 obesity and 471 in the cohort without class 3 obesity (control/comparison). The estimated effect of class 3 obesity on SGAs was calculated using adjusted odds ratios (AORs) with their 95% confidence intervals (CIs).

Results

The overall weighted prevalence of nonfunctional SGAs was 3.2%, with a significantly higher rate in the class 3 obesity cohort compared with the control cohort (4.7% vs 2.1%) (P = 0.04). This adjusted analysis illustrates that class 3 obesity was associated with an almost four times higher odds of a nonfunctional SGA (odds ratio [OR], 2.3; 95% CI, 1.0 to 5.1; AOR, 3.9; 95% CI, 1.4 to 10.6) than patients without class 3 obesity.

Conclusion

Patients with class 3 obesity (BMI ≥ 40 kg·m–2) had greater than three-fold odds of nonfunctional intraoperative SGAs than patients without class 3 obesity.

Résumé

Objectif

Les dispositifs supraglottiques (DSG) sont de plus en plus utilisés comme accès primaire aux voies aériennes en tant qu’alternative aux sondes endotrachéales chez les patient·es bénéficiant d’une anesthésie. Les dispositifs de deuxième génération ont élargi leur applicabilité pour inclure des utilisations chez les personnes souffrant d’obésité. Néanmoins, il existe des données probantes limitées concernant l’adéquation des DSG pour la patientèle souffrant d’obésité de classe 3 (indice de masse corporelle [IMC] ≥ 40 kg·m–2). Pour cette raison, nous avons comparé les taux de fonctionnalité des DSG entre une patientèle souffrant d’obésité de classe 3 et une patientèle sans obésité de classe 3 bénéficiant d’une anesthésie générale.

Méthode

Nous avons réalisé une analyse d’appariement des scores de propension en utilisant la probabilité inverse de pondération du traitement pour comparer la fonctionnalité des DSG chez la patientèle adulte atteinte d’obésité de classe 3 vs sans obésité de classe 3. Ces patient·es ont bénéficié d’une intervention chirurgicale dans un hôpital du Queensland, en Australie, entre novembre 2017 et septembre 2020, et un DSG a été inséré dans le cadre de leurs soins anesthésiques. Toutes les données ont été recueillies à partir des dossiers médicaux informatisés des patient·es. Nous avons inclus 321 personnes dans la cohorte souffrant d’obésité de classe 3 et 471 dans la cohorte sans obésité de classe 3 (témoin/comparaison). L’effet estimé de l’obésité de classe 3 sur les DSG a été calculé à l’aide de rapports de cotes ajustés (RCA) avec leurs intervalles de confiance (IC) de 95%.

Résultats

La prévalence pondérée globale des DSG non fonctionnels était de 3,2 %, avec un taux significativement plus élevé dans la cohorte avec obésité de classe 3 que dans la cohorte témoin (4,7 % vs 2,1 %) (P = 0,04). Cette analyse ajustée illustre que l’obésité de classe 3 était associée à un risque presque quadruplé de non-fonctionnalité du DSG (rapport de cotes [RC], 2,3; IC 95 %, 1,0 à 5,1; RCA, 3,9; IC 95 %, 1,4 à 10,6) que chez des patient·es sans obésité de classe 3.

Conclusion

Les personnes atteintes d’obésité de classe 3 (IMC ≥ 40 kg·m–2) présentaient plus de trois fois plus de risque de non-fonctionnalité péropératoire de DSG que les personnes sans obésité de classe 3.

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Author contributions

Patrick Hartsuyker and Marcelo E. Kanczuk contributed to the study conception, study design, and data collection and writing of the manuscript. Matthew Hiskens contributed to the study design and writing of the manuscript. Tesfaye S. Mengistu developed the study design, performed the statistical analysis, and contributed to writing of the manuscript. Matthew Hiskens, Marcelo E. Kanczuk, David Lawn, and Salwa Beg contributed to the writing and revised the manuscript for important intellectual content. All authors read and approved the final version.

Disclosures

None.

Funding statement

None.

Data availability

Data related to this work are available as tables, figures, and supplementary files.

Editorial responsibility

This submission was handled by Dr. Philip M. Jones, Deputy Editor-in-Chief, Canadian Journal of Anesthesia/Journal canadien d’anesthésie.

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Authors and Affiliations

  1. James Cook University, North Mackay, QLD, Australia

    Patrick Hartsuyker MBBS

  2. Mackay Hospital and Health Service (MHHS), Mackay Base Hospital, Mackay, QLD, Australia

    Patrick Hartsuyker MBBS, Marcelo E. Kanczuk MD, FANZCA, David Lawn MBBS & Salwa Beg MBBS

  3. Mackay Institute of Research and Innovation, Mackay Base Hospital, Mackay, QLD, Australia

    Patrick Hartsuyker MBBS, Marcelo E. Kanczuk MD, FANZCA, Tesfaye S. Mengistu PhD & Matthew Hiskens PhD

  4. School of Public Health, University of Queensland, Herston, QLD, Australia

    Tesfaye S. Mengistu PhD

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  1. Patrick Hartsuyker MBBS
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Hartsuyker, P., Kanczuk, M.E., Lawn, D. et al. The effect of class 3 obesity on the functionality of supraglottic airway devices: a historical cohort analysis with propensity score matching. Can J Anesth/J Can Anesth 70, 1744–1752 (2023). https://doi.org/10.1007/s12630-023-02582-4

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