A retrospective analysis on patients at high‐risk for obstructive sleep apnea undergoing ear, nose, and throat surgeries

Abstract

BackgroundObstructive sleep apnea (OSA) may be related to episodes of oxygen de‐saturation, hypercapnia, cardiovascular dysfunction, cor‐pulmonale, and pulmonary hypertension. STOP‐BANG is an acronym for eight specific questions used to assess the likelihood of OSA. If the individual exhibits three or more of these indicators, he/she should be considered to be at high risk for OSA complications. Therefore, the decision of proceeding with inpatient versus outpatient ENT surgery still remains controversial. The primary objective of the study was to identify and correlate desaturation (SPO2 <90%) episodes and risk factors.MethodsWe conducted a single‐center retrospective study between October 1, 2011 and August 31, 2014 in order to identify postoperative complications during the first 24 hours that justify postoperative monitoring and hospital admission. A total of 292 subjects were included for data analysis. Patients were divided into two groups based on the number of OSA risk factors: group A with 3–4 risk factors (n = 166), and group B with ≥5 risk factors (n = 126). The following information was collected: demographics, ASA, preoperative STOP‐BANG score, length of surgery, intraoperative complications, opioid consumption, post anesthesia care unit (PACU) and overall length of stay, supplemental oxygen requirement, oxygen desaturation, and postoperative opioid consumption.ResultsNo statistically significant difference was found when comparing demographic variables between both groups. All STOP‐BANG variables showed statistical significance. PACU and inpatient variables were similar among both groups, with the exception of length of hospital stay (longer stay in group B when compared to group A [p = 0.003]). Desaturation differences between both groups during PACU were statistically significant (p = 0.008). A post‐hoc analysis showed a 0% incidence of overall desaturation in the group with three STOP‐BANG indicators.ConclusionsOur retrospective analysis concluded that patients diagnosed with three STOP‐BANG risk factors did not experience postoperative complications and hospital admission was not justified.Level of Evidence4

National Analysis of 30‐Day Readmission Following Inpatient Sinus Surgery for Chronic Rhinosinusitis

“…This is interesting given that the presence of OSA commonly requires patients to be admitted to the hospital or observed in a monitored setting. Several prior studies have found that patients with OSA undergoing head and neck surgery are not at increased risk for postoperative complications and can be safely managed in an outpatient setting; our study supports these findings 23,24 . Because inpatient surgery has significantly higher costs compared to ambulatory surgery, permitting OSA patients undergoing FESS for CRS to be managed in ambulatory surgical settings with enhanced postoperative monitoring protocols would also reduce hospital expenditures.…”