BOSTN Bundle Intervention for Perioperative Screening and Management of Patients With Suspected Obstructive Sleep Apnea: A Hospital Registry Study

Abstract

BACKGROUND: We developed and implemented a perioperative guideline for obstructive sleep apnea (OSA), comprising a preoperative screening tool (BOSTN) and clinical management pathways. OSA was suspected with 2 or more of the following: body mass index ≥30 kg/m2, observed apnea, loud snoring, daytime tiredness, and neck circumference ≥16.5 inches in women or ≥ 17.5 inches in men. The primary objective of this study was to assess the association between high BOSTN scores and the requirement of invasive mechanical ventilation after surgery. METHODS: In this hospital registry study, 169,662 noncardiac surgical cases performed at Beth Israel Deaconess Medical Center (BIDMC), Boston, MA, between May 2008 and September 2017 were analyzed. We assessed the association between a high BOSTN Score (score ≥2) and the primary outcome of requirement of invasive mechanical ventilation within 7 days after surgery using multivariable logistic regression adjusted for patient-specific factors and case-specific surgical and anesthesiological confounders. Patients with a BOSTN Score ≥2 were assumed to have a high likelihood of suffering from OSA. Key secondary outcome was postoperative desaturation, defined as a peripheral oxygen saturation measurement <90% within 10 minutes of extubation. RESULTS: Invasive mechanical ventilation within 7 days of surgery was necessary in 3170 (2.3%) low-risk cases (BOSTN Score <2) and 664 (2.1%) high-risk cases (BOSTN Score ≥2). A score ≥2 was associated with significantly lower odds of requiring postoperative invasive ventilation (adjusted odds ratio [aOR], 0.89; 95% confidence interval [CI], 0.80–0.98; P = .017), but with an increased risk of postextubation desaturation (aOR, 1.34; 99.3% CI, 1.21–1.48; P < .001). Patients with a score ≥2 were hospitalized for an average of 3.71 days after surgery, compared to 4.27 days with a score <2 (adjusted incidence rate ratio [aIRR], 0.87; 99.3% CI, 0.84–0.91; P < .001). CONCLUSIONS: Patients at high risk of OSA required postoperative mechanical ventilation less frequently, had higher odds of postoperative desaturation, and were hospitalized for shorter periods of time.

A comparison of postoperative respiratory complications associated with the use of desflurane and sevoflurane: a single‐centre cohort study

“…Following a review of the literature and based on clinical plausibility, analyses were adjusted for the following patient-specific confounders: age; sex; ASA physical status; BMI; Charlson Comorbidity Index [18]; smoking and obstructive sleep apnoea history [19] (Fig. 1).…”

“…Following a review of the literature and based on clinical plausibility, analyses were adjusted for the following patient‐specific confounders: age; sex; ASA physical status; BMI; Charlson Comorbidity Index [18]; smoking and obstructive sleep apnoea history [19]; history of heart failure or chronic pulmonary disease; and a high baseline risk of postoperative pulmonary complications, that is, score for prediction of postoperative respiratory complications (SPORC) ≥ 7 [20]. Case‐specific confounders included: surgical specialty; emergency surgery; duration of surgery; work relative value units; and high‐risk surgery, that is, neurosurgery, general, transplant, thoracic, vascular or burns [20].…”

Supraglottic airway device versus tracheal intubation and the risk of emergent postoperative intubation after general anaesthesia in adults: a retrospective cohort study

“…We included a priori defined, previously established confounding variables for postoperative respiratory complications and predictors of postoperative respiratory complications, and demographic, surgery, and anaesthesiarelated covariates into a confounder model. 10,12 (Supplementary material, Sections 1.2 and 1.3). The linearity assumption was tested for all continuous variables.…”

Ventilatory frequency during intraoperative mechanical ventilation and postoperative pulmonary complications: a hospital registry study

“…Both outcomes are clinically relevant indicators of postoperative respiratory failure and have been studied before. 24,25 Mechanical ventilation and reintubation are important quality and safety indicators defined by the Agency for Healthcare Research and Quality (AHRQ). 26 Immediate post-extubation desaturation was further independently associated with adverse postoperative outcomes, including reintubation.…”