Development and validation of a Score for Preoperative Prediction of Obstructive Sleep Apnea (SPOSA) and its perioperative outcomes

Abstract

BackgroundPostoperative respiratory complications (PRCs) are associated with significant morbidity, mortality, and hospital costs. Obstructive sleep apnea (OSA), often undiagnosed in the surgical population, may be a contributing factor. Thus, we aimed to develop and validate a score for preoperative prediction of OSA (SPOSA) based on data available in electronic medical records preoperatively.MethodsOSA was defined as the occurrence of an OSA diagnostic code preceded by a polysomnography procedure. A priori defined variables were analyzed by multivariable logistic regression analysis to develop our score. Score validity was assessed by investigating the score’s ability to predict non-invasive ventilation. We then assessed the effect of high OSA risk, as defined by SPOSA, on PRCs within seven postoperative days and in-hospital mortality.ResultsA total of 108,781 surgical patients at Partners HealthCare hospitals (2007–2014) were studied. Predictors of OSA included BMI >25 kg*m−2 and comorbidities, including pulmonary hypertension, hypertension, and diabetes. The score yielded an area under the curve of 0.82. Non-invasive ventilation was significantly associated with high OSA risk (OR 1.44, 95% CI 1.22–1.69). Using a dichotomized endpoint, 26,968 (24.8%) patients were identified as high risk for OSA and 7.9% of these patients experienced PRCs. OSA risk was significantly associated with PRCs (OR 1.30, 95% CI 1.19–1.43).ConclusionSPOSA identifies patients at high risk for OSA using electronic medical record-derived data. High risk of OSA is associated with the occurrence of PRCs.Electronic supplementary materialThe online version of this article (doi:10.1186/s12871-017-0361-z) contains supplementary material, which is available to authorized users.

The obesity conundrum in sepsis

“…Despite the widespread public health initiatives to reduce the prevalence of obesity and its related comorbidities, studies in the last decade have begun to show the possible protective effects of overweight in specific diseases – a phenomenon coined as the ‘obesity paradox’ [ 1 , 2 , 6 , 7 ]. Our group also reported a similar observation: that in patients with obstructive sleep apnea – who are often obese - perioperative in-hospital mortality tends to be lower [ 8 ].…”

The association of postoperative pulmonary complications in 109,360 patients with pressure‐controlled or volume‐controlled ventilation

“… BMI, body mass index; ASA, ASA physical status; CCI, Charlson Comorbidity Index; COPD, chronic obstructive pulmonary disease; MAC, minimum alveolar concentration (of volatile anaesthetic); NDNMBA ED95, non‐depolarising neuromuscular blocking agent dose, multiples of 95% effective dose; Hypotension, minutes of mean arterial pressure < 55 mmHg; PEEP, positive end‐expiratory pressure; PRBC, packed red blood cell; RVU, relative value units; S/F, mean S P O 2 /F I O 2 ratio; SPOSA, Score for Pre‐operative Prediction of Obstructive Sleep Apnoea . …”

“…The primary outcome was major pulmonary complications within seven postoperative days, a composite of re‐intubation, pulmonary oedema, pulmonary failure or pneumonia, as defined by the ninth and tenth revisions of the International Classification of Diseases codes and by Current Procedural Terminology codes (see also Supporting Information, Table S1) . We regressed mode of ventilation and the following covariates against the primary outcome: sex; age; body mass index; ASA physical status; chronic pulmonary disease; heart failure; the Charlson Comorbidity Index ; emergency surgery; high‐risk surgery (neurosurgery, general, transplant, thoracic, vascular or burns) ; Score for Pre‐operative Prediction of Obstructive Sleep Apnoea (SPOSA) ; surgical service; duration of surgery; surgical complexity; age‐adjusted minimum alveolar concentration of inhalational anaesthetics; opioid dose in morphine equivalents; neuromuscular blocking drug dose; neostigmine dose; volumes of intra‐operative intravenous fluids and blood products; PEEP; mean S P O 2 / Fi O 2 ratio; pulmonary compliance.…”

“…We used complete cases for the primary analysis. We evaluated the potential for bias arising from missing data by repeating this analysis using multiple imputations by chained equations . We used Stata version 13 or 14 (StataCorp LLC, TX, USA) for all analyses.…”

The development and validation of the Score for the Prediction of Postoperative Respiratory Complications (SPORC‐2) to predict the requirement for early postoperative tracheal re‐intubation: a hospital registry study

“…Furthermore, we considered surgical complexity as quantified by the procedural severity score . Intra‐operative candidate variables were selected a priori based on recent literature, biological plausibility and clinical reasoning and included: desaturation (S p O 2 ≤ 90%) 5 min after tracheal intubation ; duration of surgery; median fraction of inspired oxygen (F I O 2 ) ; noradrenaline equivalent dose of vasopressors; dose of neuromuscular blocking agents (NMBA) (expressed as multiples of NMBA dose needed to reduce twitch height by 95%) ; fluid volume ; oral morphine equivalent dose ; total administered fentanyl dose; intra‐operative transfusion of packed red blood cells; use of volatile anaesthetic agents ; and the absence of lung‐protective ventilation (defined as driving pressure [plateau pressure – positive end‐expiratory pressure (PEEP)] > 15 mmHg) .…”