Extended Overnight Monitoring of Respiratory Events after Bariatric Surgery

Round 1

Reviewer 1 Report

In the manuscript  "Overnight Monitoring of Respiratory Events after Bariatric Surgery", the authors researched respiratory events in two groups of bariatric patients, a group that had OSA and a group without OSA.

My comments: the text is research that provides similar data, from research that has already been published and that the authors did not cite (https://pubmed.ncbi.nlm.nih.gov/33622605/). The goal of the previous research was approximately the same - comparison of respiratory events using two monitors, and in this research the authors compare two groups of patients, opioid free or opioid-sparing analgesia, and the same respiratory events.

The authors have also recently published a paper : https://www.mdpi.com/2673-4095/4/1/4, which has the same Ethics Committee approval number in the journal Surgeries as this study (Pro00036836, and NCT 03076047), used the same predictive score PRODIGY, OSA and non_OSA groups were compared, etc. Study status of study NCT 03076047 in the Trials.gov is RECRUITING.

In the current work, it is not stated whether it was done with the same patients.

My suggestions:

- Write why these results are published before the study is completed (NCT 03076047). This seems to be the third in a series of papers dealing with the same population, each with a slightly different number of patients and examining respiratory events. The number of patients is 64 in https://pubmed.ncbi.nlm.nih.gov/33622605/, then 80 in https://www.mdpi.com/2673-4095/4/1/4, and finally 90 in this paper.

- The paper should cite previously published research by the same group of authors.

- Write how this research differs from the previous ones, given that it has the same number of approvals from the Ethics Commitee, and the study at NCT is "recruiting"!?. The paper published in Surgery also examined the timing of respiratory events in relation to opioid administration, as well as in this paper.

- Write dates when the work was done - research period from - to.

- Follow the instructions of the author:

- an unstructured abstract of 200 words and then

- https://www.mdpi.com/journal/surgeries/instructions

After the authors have declared these issues, the paper can be re-evaluated.

Author Response

All patients studied in the present series were never utilized before. This study discuss data collection for the first postop day with new equipment and these are new data from a new series of patients for this study was expanded to another phase. 

Author Response File: Author Response.pdf

Reviewer 2 Report

1. The abstract is not structured and needs to be reorganised, corrected and conclusions need to be written.

2. The authors do not explain in the abstract the underlying mechanics of breathing in the morbidly obese and the necessary approaches. They do not specify which breathing disorder is involved and the consequences.

3. A tiny definition of OSA? The authors should clarify their knowledge of respiratory disturbances in the morbidly obese, candidates for MBS intervention and the interventions required?

4. What is the rational basis for analgesic treatment with a combination of drugs that adversely affect respiration in patients with respiratory disturbances due to morbid obesity? The authors should describe the prescribing algorithm and the pain assessment algorithm.

5. Authors should indicate how patients are managed (standard or accelerated recovery) and how they are prepared for the procedure taking into account :

Guo Y, Chen L, Gao Z, Zhang M, Liu M, Gao X, Liu Y, Zhang X, Guo N, Sun Y, Wang Y. Is esketamine-based opioid-free anesthesia more superior for postoperative analgesia in obstructive sleep apnea patients undergoing bariatric surgery? A study protocol. Front Med (Lausanne). 2022 Nov 15;9:1039042. doi: 10.3389/fmed.2022.1039042. PMID: 36457567; PMCID: PMC9705763 and
Eipe N, Budiansky AS. Perioperative Pain Management in Bariatric Anesthesia. Saudi J Anaesth. 2022 Jul-Sep;16(3):339-346. doi: 10.4103/sja.sja_236_22. Epub 2022 Jun 20. PMID: 35898528; PMCID: PMC9311177 and
de Raaff CAL, Gorter-Stam MAW, de Vries N, Sinha AC, Jaap Bonjer H, Chung F, Coblijn UK, Dahan A, van den Helder RS, Hilgevoord AAJ, Hillman DR, Margarson MP, Mattar SG, Mulier JP, Ravesloot MJL, Reiber BMM, van Rijswijk AS, Singh PM, Steenhuis R, Tenhagen M, Vanderveken OM, Verbraecken J, White DP, van der Wielen N, van Wagensveld BA. Perioperative management of obstructive sleep apnea in bariatric surgery: a consensus guideline. Surg Obes Relat Dis. 2017 Jul;13(7):1095-1109. doi: 10.1016/j.soard.2017.03.022. Epub 2017 Mar 30. PMID: 28666588.

Minor English corrections according to the topic.

Author Response

Thank you for your comments. response to all concerns advanced by all. 

 

 I clarify that the present series of obesity surgery patients (52 OSA plus 38 non-OSA) is a new series assembled only for this publication and do not comprise any patient described in our previous publication. 

 

Our previous paper published in Surgeries evaluated the respiratory effect of patients during the early recovery phase after obesity surgery, limited to three hours of observation in the post-anesthesia care unit (PACU). This paper was quoted in the original manuscript as reference 14. And now 15.  

 

The new manuscript presently submitted evaluates an extended period of recovery after discharge from PACU to a ward, up to 18 hours post-discharge, practically comprising the first evening and first night post-operative. For further clarity, we propose to modify our title with the insertion of an additional adjective:  Extended.  The proposed title now reads, “Extended overnight monitoring of respiratory events after bariatric surgery.” 

 

Affiliations of the authors have been added as required. 

 

The abstract was scored as requested and significantly shortened.  

 

Keywords have been appropriately added. 

 

All sections of the Back Matter have been completed as requested. 

 

In the text, on  lines 64 and passim, we clarify the protocol number of our IRB as a second extension obtained from our USF Institution. 

 

We specify the times of data collection from February 2022 to May 2023. 

 

In Methods, we added an appropriate reference provided by the second reviewer (thank you): this is added as #10 in this corrected version; therefore, there is a change in all the numeral order of quotations after 10, which are adjusted. The second suggested reference was already in our text, quoted as N 1. 

 

We added additional details for the OSA diagnosis indicating the Stop-bang and other methods used to classify patients, starting in line 73 and passim. 

 

We re-evaluated the correct language by analyzing the whole paper with Grammarly software. 

 

This fully corrected version of the paper is now appended in Word. 

Round 2

Reviewer 1 Report

In this revised version of the manuscript, the authors presented a new group of patients not shown in previous studies. They compared opioid consumption intraoperatively and in the early postoperative period and examined the association with RE in a patient undergoing bariatric surgery. 

Comments: An abstract still has >400 instead of 200 words. 

Keywords: "post operative opiates" and "postoperative opioids" may be the same, remove one.

Add the name of the manufacturer and country of origin for all devices used.

As you have shown in the tables, add the number of patients in each group in the pictures (or in their notes),  too.

Author Response

Please see attachment. 

Author Response File: Author Response.pdf