Perioperative impact of sleep apnea in a high-volume specialty practice with a strong focus on regional anesthesia: a database analysis

Abstract

Background and objectivesObstructive sleep apnea (OSA) is a risk factor for adverse postoperative outcome and perioperative professional societies recommend the use of regional anesthesia to minimize perioperative detriment. We studied the impact of OSA on postoperative complications in a high-volume orthopedic surgery practice, with a strong focus on regional anesthesia.MethodsAfter Institutional Review Board approval, 41 766 cases of primary total hip and knee arthroplasties (THAs/TKAs) from 2005 to 2014 were extracted from institutional data of the Hospital for Special Surgery (approximately 5000 THAs and 5000 TKAs annually, of which around 90% under neuraxial anesthesia).The main effect was OSA (identified by the International Classification of Diseases, ninth revision codes); outcomes of interest were cardiac, pulmonary, gastrointestinal, renal/genitourinary, thromboembolic complications, delirium, and prolonged length of stay (LOS). Multivariable logistic regression models provided ORs, corresponding 95% CIs, and p values.ResultsOverall, OSA was seen in 6.3% (n=1332) of patients with THA and 9.1% (n=1896) of patients with TKA. After adjustment for relevant covariates, OSA was significantly associated with 87% (OR 1.87, 95% CI 1.51 to 2.30), 52% (OR 1.52, 95% CI 1.13 to 2.04), and 44% (OR 1.44,95% CI 1.31 to 1.57) increased odds for pulmonary gastrointestinal complications, and prolonged LOS, respectively. The odds for other outcomes remained unaltered by OSA diagnosis.ConclusionWe showed that, even in a setting with almost universal regional anesthesia use, OSA was associated with increased odds for prolonged LOS, and pulmonary and gastrointestinal complications. This puts forward the question of how effective regional anesthesia is in mitigating postoperative complications in patients with OSA.

Perioperative Sleep Disturbances and Postoperative Delirium in Adult Patients: A Systematic Review and Meta-Analysis of Clinical Trials

“…In one retrospective trial, the control group was matched for age, sex, operated side, type of operation, mode of component fixation, year of operation, surgeon, and type of anesthesia ( 28 ). In seven trials, patients only underwent cardiac surgery ( 33 , 36 – 39 , 42 , 44 ), in 20 trials, only non-cardiac surgeries ( 17 , 18 , 27 – 30 , 32 , 34 , 35 , 40 , 41 , 43 , 45 – 52 ), and in two trials, both cardiac and non-cardiac surgeries ( 16 , 31 ). All the patients in the included RCTs underwent non-cardiac surgeries.…”

“…We obtained the mean age of patients in each study by adding the mean age of patients in each group and then dividing by two. In 19 trials, the mean age was 65 years or older ( 17 , 18 , 28 , 30 – 32 , 34 , 35 , 37 – 40 , 45 , 46 , 48 – 52 ), though one trial did not provide participants' ages ( 36 ). Males accounted for 50% or more of all patients in 16 trials ( 16 – 18 , 28 , 31 , 33 , 35 , 37 – 39 , 41 – 45 , 47 ), though two trials did not provide sex-related information ( 36 , 51 ).…”

“…Three trials did not disclose their method for assessing sleep disturbance ( 27 , 32 , 38 ). Nine trials focused on patients with sleep-disorder breathing or OSA ( 16 , 28 , 30 , 31 , 34 , 37 , 39 , 41 , 49 ), and the other trials studied patients with several sleep problems. Thirteen trials described the effect of preoperative sleep problems on the incidence of POD ( 16 , 27 , 28 , 30 , 31 , 33 – 35 , 37 , 39 – 42 ), and the other trials described postoperative sleep quality.…”

“…The numbers of patients with good and poor sleep quality are shown in Table 3 , alongside the numbers of patients with and without POD in each group. The onset time of POD was more than 3 days after surgery in 21 trials ( 16 – 18 , 27 – 30 , 32 , 33 , 35 – 38 , 40 – 45 , 48 , 51 ).…”

OSA and adverse perioperative outcomes: we should distinguish them

“…We have read with great interest the manuscript of Pichler et al 1 We want to congratulate the authors for their highly valuable study that brings some important information. They conclude that regional anesthesia could not be effective in mitigating postoperative complications in patients with obstructive sleep apnea (OSA).…”