A Matched Cohort Study of Postoperative Outcomes in Obstructive Sleep Apnea

Mutter, Thomas C; Château, Dan; Moffatt, Michael; Ramsey, Clare D.; Roos, Leslíe L.; Kryger, Meir H.

doi:10.1097/aln.0000000000000407

Cited by 203 publications

(79 citation statements)

References 42 publications

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“…[8,31–36] Increasing severity of sleep disordered breathing is associated with increased risk of complications after surgery. [37] This may indeed explain the association of increased early PRC seen with longer PACU oxygen requirement in the propensity matched analyses. This outcome association occurred despite the fact that suspected OSA as screened by the PSAP score was well balanced across the matched groups.…”

Section: Discussionmentioning

confidence: 95%

Retrospective observational evaluation of postoperative oxygen saturation levels and associated postoperative respiratory complications and hospital resource utilization

et al. 2017

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IntroductionThe clinical importance of postoperative episodic hypoxemia is still unclear, and therefore largely under-studied. As a result, there is limited understanding of its relationship with early postoperative respiratory complications (PRC, defined as intubation within three days of surgery) and hospital resource utilization.Materials and methodsThis single center study was performed using a retrospective observational design. We described population based definitions of desaturation from continuous SpO2 monitoring data captured in the post anesthesia care unit (PACU), namely median SpO2 in PACU, duration of desaturation below median, nadir desaturation, and length of oxygen therapy relative to PACU duration. These measures were evaluated against the occurrence of early PRC in logistic regression models. Measures that were independently associated with early PRC were accepted as the primary study exposures. Stratified logistic regression models were planned if significant interaction occurred with high risk surgical procedures. Models were adjusted by including several patient conditions, procedural, and anesthesia risk factors. Propensity matching on desaturation occurrence was planned to evaluate the relationship with postoperative resource utilization.ResultsAmong 125,740 patients included in the univariate analyses, 351 patients (0.3%) developed early PRC. Nadir desaturation <89% [14.3% of patients; adjusted odds ratio 2.02; 95% CI 1.52, 2.68; p<0.001] and PACU oxygen therapy requirements greater than 60 min [adjusted odds ratio 1.92 (>60 min) to 3.04 (>90 min); p<0.001] were identified as independent predictors of early PRC occurrence. A modest interaction was observed between desaturation and higher surgical risk. Propensity matching for postoperative oxygen requirement was performed in 37,354 matched patients. Matched analysis demonstrated significant increase in day of surgery charges, respiratory charges, total charges, hospital length of stay, reintubation and use of invasive or non-invasive ventilatory support.ConclusionsIn summary, we report that prolonged PACU oxygen therapy and nadir desaturation <89% in PACU as captured in a retrospective database are independently associated with early PRC. This study describes resource implications of PACU desaturation in a large academic medical center in North America.

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Section: Discussionmentioning

confidence: 95%

Retrospective observational evaluation of postoperative oxygen saturation levels and associated postoperative respiratory complications and hospital resource utilization

et al. 2017

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“…Postoperatif CPAP/NIV gereksinimi açısından, obez hastalar aşağıdaki alt gruplara ayrılabilir: a) OUA tanısı konulmamış obez hastalar Bu hastalarda oksijen tedavisi (yüz maskeli veya nazal kanül), dik pozisyon ve erken mobilizasyon yeterlidir. Retrospektiv analizler, birçok bariyatrik cerrahi hastalarda OUA tanısının sıklıkla gözden kaçtığını göstermiştir ve bu hasta grubunda postoperatif komplikasyon gelişme riski yüksektir (109)(110)(111) .…”

Section: Non-invaziv Pozitiv Basınçlı Ventilasyonunclassified

“…NIPP kullanımı için hastaya bağlı risk faktörleri orta veya şiddetli OUA, erkek cinsiyet, >50 yaş, VKİ >60 kg/m 2 , pulmoner komorbidite, açık cerrahidir (112)(113)(114) . Ameliyat sonrası dönemde oksijen satürasyonunun %90'nın altında olması hipoksi olarak tanımlanır ve NIPP'e gereksinim olduğunu gösterir (110) . OHS, uyanıklık hipoksisi ve hiperkarbisi olan ve artmış serum bikarbonat (>27 mmol/L) düzeyi olan ağır obez hastalar olarak tanımlanmaktadır.…”

Section: B) Preoperatif Cpap Tedavisi Almayan Oua Olan Hastalarunclassified

The Enhanced Recovery After Surgery (ERAS) Protocol Implementations in Non-Colorectal Gastrointestinal Surgical Procedures; Bariatric, Hepatobiliary, Pancreaticoduodenectomy, Gastrectomy

Kalaycı¹,

Dagistanli²,

Kara³

2018

IKSST

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Kolorektal cerrahi ile başlayan ERAS uygulamalarında modern hasta bakımı yaklaşımı ile sağlanan ümit verici gelişmeler laparoskopiden, bariatrik cerrahiye, hepatikopankreatik cerrahi girişimlerden meme rekonstrüksiyonuna uzanmıştır. ERAS uygulamaları geleneksel yaklaşımın kanıta dayalı değerlendirmelerle ölçülmesi, örneklenmesi ve öğreti yoluyla hasta ve sağlık uygulayıcılarının yeniden deneyimlediği bakım sürecinin kontrolünü sağlamıştır. Tüm disiplinlerde daha kısa yatış süreleri elde edilirken, disiplin ayrıcalıklı yeni yaklaşım modaliteleri de gelişmiştir. Bariatrik cerrahide operasyon öncesi kilo kontrolü, alkolsigara kullanımı kısıtlamaları, sıvı ve solunum fizyolojisine yaklaşım farklılıkları, meme cerrahisinde opioid kullanımının azaltılması, pankreas tümörlerindeki girişimlerde biliyer drenaj gereksiniminin değerlendirilmesi vb. gibi farklılıkları getirmiştir. Hâlen tüm genel cerrahi disiplinlerde sürecin kontrolü ve sorgulanması amacıyla yeni metodoloji ve uygulamaların değerlendirildiği çalışmalara gereksinim vardır.

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“…111 Two large retrospective database studies provide incremental evidence that confirms the benefits of establishing the diagnosis of OSA preoperatively and provide a preliminary rationale for treating OSA with CPAP during the perioperative period. 112,113 Consideration should be given to using CPAP or an oral appliance during sedation to patients previously treated with these modalities. 108 Some patients may be nonadherent to CPAP therapy.…”

Section: Osa In Surgical Patientsmentioning

confidence: 99%

Understanding Phenotypes of Obstructive Sleep Apnea: Applications in Anesthesia, Surgery, and Perioperative Medicine

Subramani¹,

Singh²,

Wong

et al. 2017

Anesthesia &Amp; Analgesia

129

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Obstructive sleep apnea (OSA) is a prevalent sleep-disordered breathing with potential long-term major neurocognitive and cardiovascular sequelae. The pathophysiology of OSA varies between individuals and is composed of different underlying mechanisms. Several components including the upper airway anatomy, effectiveness of the upper airway dilator muscles such as the genioglossus, arousal threshold of the individual, and inherent stability of the respiratory control system determine the pathogenesis of OSA. Their recognition may have implications for the perioperative health care team. For example, OSA patients with a high arousal threshold are likely to be sensitive to sedatives and narcotics with a higher risk of respiratory arrest in the perioperative period. Supplemental oxygen therapy can help to stabilize breathing in OSA patients with inherent respiratory instability. Avoidance of supine position can minimize airway obstruction in patients with a predisposition to upper airway collapse in this posture. In this review, the clinically relevant endotypes and phenotypes of OSA are described. Continuous positive airway pressure (CPAP) therapy is the treatment of choice for most patients with OSA but tolerance and adherence can be a problem. Patient-centered individualized approaches to OSA management will be the focus of future research into developing potential treatment options that will help decrease the disease burden and improve treatment effectiveness.

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A Matched Cohort Study of Postoperative Outcomes in Obstructive Sleep Apnea

Cited by 203 publications

References 42 publications

Retrospective observational evaluation of postoperative oxygen saturation levels and associated postoperative respiratory complications and hospital resource utilization

Retrospective observational evaluation of postoperative oxygen saturation levels and associated postoperative respiratory complications and hospital resource utilization

The Enhanced Recovery After Surgery (ERAS) Protocol Implementations in Non-Colorectal Gastrointestinal Surgical Procedures; Bariatric, Hepatobiliary, Pancreaticoduodenectomy, Gastrectomy

Understanding Phenotypes of Obstructive Sleep Apnea: Applications in Anesthesia, Surgery, and Perioperative Medicine

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