Postoperative Complications in Patients with Obstructive Sleep Apnea.
Chest. 2011 Aug 25;
Authors: Kaw R, Pasupuleti V, Walker E, Ramaswamy A, Foldvary-Schafer N
Abstract
Abstract BACKGROUND: Unrecognized obstructive sleep apnea (OSA) is associated with unfavorable perioperative outcomes among patients undergoing non-cardiac surgery (NCS). METHODS: Our study population was chosen from 39,771 patients who underwent internal medicine preoperative assessment between January 2002 and December 2006. Patients undergoing NCS within 3 years of polysomnography (PSG) were considered for the study, whileas those < 18 years of age; with history of upper airway surgery and minor surgery under local or regional anesthesia were excluded. Patients with an apnea-hypopnea index (AHI) ?5 were defined as OSA and those with AHI <5 as controls. For adjusting baseline differences in age, sex, race, BMI, type of anesthesia, American Society of Anesthesiology class and medical co-morbidities, the patients were classified into five quintiles according to a propensity score. RESULTS: Out of a total of 1759 patients who underwent both Polysomnography and NCS, 471 met the study criteria. Of these 282 patients had OSA and the remaining 189 served as controls. Presence of OSA was associated with higher incidence of postoperative hypoxemia (OR= 7.9; p=0.009), overall complications (OR= 6.9; p=0.003); ICU transfer (OR 4.43; p=0.069) and higher length of hospital stay, (OR= 1.65; p=0.049). Neither AHI, nor use of home CPAP before surgery was associated with postoperative complications (p=0.3; 0.75 respectively) or length of stay (p = 0.97; 0.21 respectively). CONCLUSIONS: Patients with OSA are at higher risk for postoperative hypoxemia, ICU transfers and longer hospital stay.
PMID: 21868464 [PubMed - as supplied by publisher]