Perioperative Pulmonary Outcomes in Patients With Sleep Apnea After Noncardiac Surgery

Memtsoudis, Stavros G.; Liu, Spencer S.; Ma, Yan; Chiu, Ya Lin; Walz, J. Mathias; Gaber-Baylis, Licia K.; Mazumdar, Madhu

doi:10.1097/sa.0b013e318254db0c

Cited by 64 publications

(111 citation statements)

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“…Our intuition is that the probability of k independent judges reaching the wrong conclusion decreases exponentially as k increases [4,5]. Lastly, lack of consensus can be unsettling to those seeking expert opinion and researchers who have found particularly low levels of consensus within certain specialties have concluded a general lack of expertise within those fields [4,[6][7][8]. Notable among these were stockbroking and peer-reviewing.…”

Section: Editorialmentioning

confidence: 99%

“…Obstructive sleep apnoea (OSA) is associated with increased adverse peri-operative outcomes [1][2][3][4][5][6][7][8]. Studies of several large populationbased databases, including millions of patients and two meta-analyses, have shown that patients with OSA have an increased risk of postoperative complications [1][2][3][4][5][6][7].…”

mentioning

confidence: 99%

“…Studies of several large populationbased databases, including millions of patients and two meta-analyses, have shown that patients with OSA have an increased risk of postoperative complications [1][2][3][4][5][6][7]. Many adverse postoperative events will be resolved by a longer stay in recovery, but some can be profound and result in mortality (dead-in-bed), as well as life-threatening situations requiring admission to a high dependency (HDU) or intensive care unit (ICU) [9].…”

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confidence: 99%

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The importance of obstructive sleep apnoea management in peri-operative medicine

2016

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Section: Editorialmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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The importance of obstructive sleep apnoea management in peri-operative medicine

2016

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“…Some studies have reported specifically on pneumonia and pulmonary embolism as outcomes [22,101,102,[105][106][107][108][109]. There is no clear consensus regarding the association of pneumonia and OSA in the perioperative setting as some studies report an association (general surgery, orthopedic surgery) [101,105,109] whereas others do not (bariatric surgery, orthopedic surgery) [22,102,108].…”

Section: Pulmonary Complicationsmentioning

confidence: 99%

“…With two exceptions [22,102], studies reporting on postoperative respiratory failure have found an association between a diagnosis of OSA and higher rates of this complication (OR 1.6-4.3, all statistically significant). The studies reporting an association have used PSG confirmation [104,105] or ICD coding [101,103•] to define OSA, whereas one of the studies that did not find an association used a screening questionnaire to define low and high risk for OSA populations [22]. The other study not finding an association with respiratory failure and an ICD code for OSA noted much higher rates of reintubation (OR 4.4) and CPAP/noninvasive ventilation use (OR 14.1), but not respiratory failure, which suggests potential methodological issues affecting the analysis [102].…”

Section: Pulmonary Complicationsmentioning

confidence: 99%

Perioperative Complications in Obstructive Sleep Apnea Patients

Auckley

2016

Curr Sleep Medicine Rep

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Obstructive sleep apnea (OSA) is growing in prevalence though it still remains significantly underdiagnosed. Preoperative screening for OSA is taking place in many institutions, with a substantial number of patients being identified as having a high probability for OSA just prior to undergoing surgery. Emerging data increasingly demonstrates that patients with a high probability of having OSA as well as those with a known diagnosis of OSA may be at increased risk for developing complications in the perioperative setting. Postoperative cardiac and pulmonary adverse events appear to occur more frequently in these patients though the impact OSA has on postoperative mortality is controversial. In addition, determining which patients are at greatest risk remains an area of uncertainty. This chapter will review the current state of the knowledge regarding OSA as a risk factor for perioperative complications.

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A cost-effectiveness analysis of nasal surgery to increase continuous positive airway pressure adherence in sleep apnea patients with nasal obstruction

et al. 2016

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Objectives/Hypothesis Nasal surgery has been implicated to improve continuous positive airway pressure (CPAP) compliance in patients with obstructive sleep apnea (OSA) and nasal obstruction. However, the cost-effectiveness of nasal surgery to improve CPAP compliance is not known. We modeled the cost-effectiveness of two types of nasal surgery versus no surgery in patients with OSA and nasal obstruction undergoing CPAP therapy. Study Design Cost-effectiveness decision tree model. Methods We built a decision tree model to identify conditions under which nasal surgery would be cost-effective to improve CPAP adherence over the standard of care. We compared turbinate reduction and septoplasty to nonsurgical treatment over varied time horizons from a third-party payer perspective. We included variables for cost of untreated OSA, surgical cost and complications, improved compliance postoperatively, and quality of life. Results Our study identified nasal surgery as a cost-effective strategy to improve compliance of OSA patients using CPAP across a range of plausible model assumptions regarding the cost of untreated OSA, the probability of adherence improvement, and a chronic time horizon. The relatively lower surgical cost of turbinate reduction made it more cost-effective at earlier time horizons, whereas septoplasty became cost-effective after a longer timespan. Conclusions Across a range of plausible values in a clinically relevant decision model, nasal surgery is a cost-effective strategy to improve CPAP compliance in OSA patients with nasal obstruction. Our results suggest that OSA patients with nasal obstruction who struggle with CPAP therapy compliance should undergo evaluation for nasal surgery.

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Perioperative Pulmonary Outcomes in Patients With Sleep Apnea After Noncardiac Surgery

Cited by 64 publications

References 0 publications

The importance of obstructive sleep apnoea management in peri-operative medicine

The importance of obstructive sleep apnoea management in peri-operative medicine

Perioperative Complications in Obstructive Sleep Apnea Patients

A cost-effectiveness analysis of nasal surgery to increase continuous positive airway pressure adherence in sleep apnea patients with nasal obstruction

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