Retrospective audit of anaesthesia practices in a new Bariatric unit in a Johannesburg academic hospital

Abstract

Background: Obesity is a significant issue in South Africa, where 27% of the population is considered obese and this is estimated to increase. Bariatric surgery is currently offered at four public institutions in South Africa. There is limited literature on the anaesthetic practice in bariatric surgery in South Africa. Aim: To describe perioperative anaesthetic practices for bariatric surgery. Setting: Helen Joseph Hospital. Methods: This was a retrospective, descriptive study that included all bariatric cases performed from 01 January 2022 to 30 June 2024. The data collection sheet was designed in accordance with the perioperative recommendations of the Enhanced Recovery After Surgery (ERAS) Society for Bariatric Surgery. Pre-, intra- and postoperative variables were reviewed. Outcomes were descriptively described. Results: Forty-three patients met the inclusion criteria; 90% were female, with a median age of 45 years and a median body mass index of 59 kg/m2. Although all patients met the prerequisites for surgery, only 65% achieved the recommended preoperative weight loss. Opioid-sparing analgesia and multimodal postoperative nausea and vomiting (PONV) prophylaxis were administered to 55% and 78% of patients, respectively. Postoperative prophylactic oxygen was provided to 86% of patients. PONV was the most common complication (16.3%), and overall mortality was 7%. Conclusion: This was the first public-sector audit of bariatric surgery in South Africa analysing current anaesthetic practice. Intraoperative practices had higher compliance with ERAS guidance, and postoperative practices had the lowest compliance. Multidisciplinary involvement for context-specific guidance will ensure standardised care for these patients throughout the perioperative period. Contribution: The study provides insight into current anaesthesia practices for bariatric surgery at a single centre in South Africa. It highlights areas for improvement to align practice with international guidelines.