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Accuracy of Oxygen Saturation Measurements in Patients with Obesity Undergoing Bariatric Surgery

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Abstract

Background

We aimed to determine the magnitude, direction, and influencing factors of the concordance between arterial oxygen saturation (SaO2) and peripheral capillary oxygen saturation (SpO2) in patients with obesity undergoing bariatric surgery, supporting the measurement of SaO2 and SpO2 in key populations.

Methods

Patients with obesity undergoing bariatric surgery from 2017 to 2020 were included. Preoperative SpO2 and SaO2 were collected. Linear correlation and multiple linear regression analyses were performed to characterize the relationships between body mass index (BMI), age, and sex with pulse oximetry and arterial blood gas (ABG) parameters. Bland–Altman analysis was applied to determine the concordance between SpO2 and SaO2 and the limits of this concordance.

Results

A total of 134 patients with obesity undergoing bariatric surgery were enrolled. SaO2 was negatively associated with BMI (p < 0.0001) and age (p = 0.006), and SpO2 was negatively associated with BMI (p = 0.021) but not with age. SpO2 overestimated SaO2 in 91% of patients with a bias of 2.05%. This bias increased by 203% in hypoxemic patients compared with nonhypoxemic patients (p < 0.0001). The bias was 1.3-fold higher (p = 0.023) in patients with a high obesity surgery mortality risk score (OS-MRS) than in those with low or intermediate scores.

Conclusion

Compared with SpO2, preoperative SaO2 can more accurately reflect the real oxygen saturation in patients with obesity undergoing bariatric surgery, especially for those with BMI ≥ 40 kg/m2, age ≥ 40 years, and high OS-MRS. ABG analysis can provide a more reliable basis for accurate and timely monitoring, ensuring the perioperative safety of susceptible patients.

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Acknowledgements

We thank the members of the Department of Metabolic and Bariatric Surgery (Drs. Cunchuan Wang, Jingge Yang, and Zhiyong Dong) and the Department of Anesthesiology (Drs. Donghua Hu, Shane Duan, and Peng Zou), the First Affiliated Hospital of Jinan University, for their support of this study.

Author information

Author notes

  1. Yibo Xiong and Guifeng Pan have contributed equally to this work.

  2. Ji Miao and Xuemei Peng have contributed equally to this work.

Authors and Affiliations

  1. Department of Anesthesiology, The First Affiliated Hospital, Jinan University, No. 613, Huangpu Avenue West, Guangzhou, 510632, Guangdong, China

    Yibo Xiong, Guifeng Pan, Weixin Huang & Xuemei Peng

  2. Division of Endocrinology, Boston Children’s Hospital, Harvard Medical School, Boston, MA, 02115, USA

    Yibo Xiong, Ruixiang Hu, Liang Chen & Ji Miao

  3. Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital, Jinan University, No. 613, Huangpu Avenue West, Guangzhou, 510632, Guangdong, China

    Wah Yang & Ruixiang Hu

  4. Department of Anesthesiology, The Affiliated Shunde Hospital, Jinan University, No. 50, Guizhou Avenue, Foshan, 528305, Guangdong, China

    Ying Mai

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  1. Yibo Xiong
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Contributions

XP and JM conceived the study; YX, GP, and WH collected the data; XP, JM, YX, RH, YM, and LC analyzed the data; XP, JM, YX, GP, and WY wrote the manuscript; and all authors reviewed and approved the manuscript.

Corresponding authors

Correspondence to Ji Miao or Xuemei Peng.

Ethics declarations

Ethics Approval

This study was approved by the ethics committee of the First Affiliated Hospital of Jinan University (Ethics Approval No. KY-2019–023).

Consent to Participate

Informed consent was obtained from all individual participants included in the study.

Conflict of Interest

The authors declare no competing interests.

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Key Points

• SpO2 overestimates SaO2 in patients with obesity.

• SaO2 better reflects the lower oxygen saturation in older male patients.

• The inaccuracy of SpO2 increases with BMI, age, and OS-MRS.

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Xiong, Y., Pan, G., Huang, W. et al. Accuracy of Oxygen Saturation Measurements in Patients with Obesity Undergoing Bariatric Surgery. OBES SURG 32, 3581–3588 (2022). https://doi.org/10.1007/s11695-022-06221-7

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