The Impact of Sleep Apnea on Postoperative Utilization of Resources and Adverse Outcomes

Abstract

Background Despite the concern that sleep apnea (SA) is associated with increased risk for postoperative complications, a paucity of information is available regarding the effect of this disease on postoperative complications and resource utilization in the orthopedic population. With an increasing number of surgical patients suffering from SA, this information is of high importance to physicians, patients, policymakers and administrators alike. Methods We analyzed hospital discharge data of patients who underwent total hip or knee arthroplasty (THA, TKA) in approximately 400 United States hospitals between 2006 and 2010. Patient, procedure, and healthcare-system related demographics and outcomes such as mortality, complications, and resource utilization were compared amongst groups. Multivariable logistic regression models were fit to assess the association between SA and various outcomes. Results We identified 530,089 entries for patients undergoing THA and TKA. Of those, 8.4% had a diagnosis code for SA. In the multivariate analysis, the diagnosis of SA emerged as independent risk factor for major postoperative complications (OR 1.47 (95% CI 1.39;1.55)). Pulmonary complications were 1.86 (95% CI 1.65; 2.09) times more likely and cardiac complications 1.59 (95% CI 1.48; 1.71) times more likely to occur in patients with SA. In addition, SA patients were more likely to require ventilatory support, utilize more intensive care, step-down and telemetry services, consume more economic resources, and require increased lengths of hospitalization. Conclusions The presence of SA represents a major clinical and economic challenge in the postoperative period. More research is needed to identify SA patients at risk for complications and develop evidence-based practices in order to aid in the allocation of clinical and economic resources.

Postoperative Complications Associated with Obstructive Sleep Apnea

“…Not surprisingly, the association was stronger with pulmonary complications (OR 1.86; 95% CI, 1.65-2.09) than cardiac complications (OR 1.59; 95% CI, 1.48-1.71) with the risk of cardiac complications mainly due to atrial fibrillation. 8 In the study by Memtsoudis et al, 12 despite the increased rates of complications, there was no significant increase in the risk of in-hospital mortality in patients with OSA. 13 The risk of emergent reintubation was significantly increased in patients with OSA (OR 10.26; 95% CI, 9.01-11.69).…”

Obstructive Sleep Apnea: Emphasis on Discharge Education After Surgery

“…They utilize more medical resources, and have an increased medical disability compared to patients without OSA. [30][31][32][33] Also, they have more ED visits or urgent care, which often times lead to hospital admission. 1,34 At the community health system's perioperative services, approximately 40-50 patients with OSA have surgery every month.…”

Perioperative Opioid Usage

“…[41][42][43] Apneic episodes are likely to be observed and corrected in the post-anesthesia care unit with decreased nursing-to-patient ratios. [45][46][47] The additive properties of sedative medications may also play a role in obstructive episodes. Postoperative desaturation is fairly common in this population, 44 and cardiorespiratory complications occur more frequently.…”