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EP197 Impact of obesity on clinically significant respiratory events following cesarean delivery: is a 24-hour high acuity setting necessary for patients with BMI >50 kg/m2
  1. Tural Alekberli1,
  2. Luz Bueno Rey1,
  3. Kristi Downey1,
  4. Jose Carvalho1,
  5. Cynthia Maxwell2 and
  6. Naveed Siddiqui1
  1. 1Department of Anesthesia and Pain Management, University of Toronto, Mount Sinai Hospital, Toronto, Canada
  2. 2Department of Obstetrics and Gynecology, University of Toronto, Mount Sinai Hospital, Toronto, Canada


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.

Abstract EP197 Table 1

Patient characteristics and incidence of postoperative respiratory events

Abstract EP197 Figure 1

Comparison of the respiratory events (%) per study groups

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

  • BMI
  • High BMI
  • Respiratory Event
  • Obesity
  • Cesarean Delivery
  • Neuraxial Opioid

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