DP35: PREOPERATIVE ULTRASOUND MEASUREMENT OF TONGUE DIMENSIONS PREDICTS POSTOPERATIVE DESATURATION IN BARIATRIC SURGERY PATIENTS WITH OSA
Ryan Shargo1; Brandon Dyer1; Samantha Malak1; Naveen Perisetla1; Andrea Vrionis1; Jose Malavet1; John Hodgson, MD2,3; Christopher Ducoin, MD4; Enrico Camporesi, MD2,3
1University of South Florida Morsani College of Medicine; 2Department of Anesthesiology and Perioperative Medicine, Morsani College of Medicine; 3TEAMHealth, Anesthesia, Tampa General Hospital; 4Department of Surgery, University of South Florida Morsani College of Medicine
Background: Bariatric patients are at increased risk for postoperative oxygen desaturation, with obstructive sleep apnea (OSA) being a key contributing factor. Ultrasound measurements of tongue size have been previously used to assess OSA severity (Kalkanis et al 2023). This study evaluates the relationship between tongue size and postoperative desaturation events among patients undergoing bariatric surgery.
Methods: Tongue sagittal and transverse diameters were collected via ultrasound from 100 patients who underwent bariatric surgery at a tertiary care center between May 2024 and December 2024 (IRB protocol 00036836). Patients underwent robotic surgery and received opioid-sparing anesthesia. Continuous postoperative respiratory monitoring was conducted using a bedside, noninvasive device. A desaturation event was defined as a drop in SpO2 by 3% for at least 30 seconds or a drop in SpO2 < 89%. The tongue cross-sectional area was determined by multiplying sagittal and transverse tongue diameters. Statistical analyses included descriptive statistics, Mann-Whitney U tests, and Spearman’s rank correlation to compare demographic and clinical variables stratified by tongue diameter.
Results: 100 patients were included in the final sample, of which 88 were female. The median patient age was 46.5 years (IQR = 20.3), with a median BMI of 41.2 (IQR = 8.91). Sixty-four patients had a previous diagnosis of OSA. Patients with OSA experienced significantly more desaturation events than those without OSA (11.1 vs. 2.25, p = 0.007). Tongue size was weakly correlated with BMI (rho = 0.207, p = 0.039). The tongue cross-sectional area was positively correlated with desaturation events between 4-6 hours postoperatively (p = 0.03). When stratified by PRODIGY risk and OSA status, tongue size in the intermediate PRODIGY risk, OSA-positive group was correlated with more time spent with SpO2 < 89% (rho = 0.454, p = 0.039). Patients who experienced 30-day complications had a significantly larger median sagittal tongue size (9.6 cm vs. 8.2 cm, p = 0.044).
Conclusion: Significant correlations between tongue size and desaturation events were observed when stratifying by OSA status and intermediate PRODIGY risk scores. Increased sagittal tongue size was associated with 30-day complications, suggesting its potential as a predictive marker for adverse postoperative outcomes. These findings highlight the utility of preoperative ultrasound-based tongue measurements as a supplementary tool for identifying bariatric surgery patients at higher risk of desaturation. Further research is warranted to validate these findings and refine risk stratification protocols in bariatric surgery patients.
