Background and Aims Pregnant people with obesity class 3 are thought to be at higher risk of adverse respiratory-events. There is little information in the literature on the incidence and severity of obesity-related postpartum respiratory depression. Our institution’s current standard of practice is to consider maintaining patients with BMI>50 who have received long-acting neuraxial opioids following cesarean delivery(CD) in the Labour and Delivery Unit for respiratory monitoring. This represents a significant workload for the system. This study aimed to determine the incidence of respiratory complications in this subset of patients.
Methods We reviewed medical records of patients with BMI>40 who underwent CD and received long-acting neuraxial opioids between January 2015- December 2022. Patients were divided into three groups according to their BMI: 40-49, 50-59, and >60. Clinically significant respiratory-events (see the definition in table 1) within the first 24 hours post-CD were compared.
Results Demographics, patient characteristics, comorbidities, and respiratory events are presented in table 1. No severe respiratory events were observed in any of the groups from 497 patients (figure 1). Three moderate respiratory-events were observed, one in each group. Thirteen, 9 and 5 mild respiratory-events were observed in BMI 40-49, 50-59, and >60groups, respectively.
Conclusions Our results suggest that there is no association between BMI and severe respiratory-events after CD under neuraxial anesthesia and the use of long- acting neuraxial opioids. Extended admission to a high-acuity setting may not be necessary for the majority of these patients. In addition to BMI, the presence of patient comorbidities and physician assessment may prove valuable in determining the necessity for admission.
Initial Ethics Commity Approval Letter 22-0202-C
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