The Impact of Sleep Apnea on Postoperative Utilization of Resources and Adverse Outcomes
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 disorder on postoperative complications and resource utilization in the orthopedic population. With an increasing number of...
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| Published in: | Anesthesia and analgesia Vol. 118; no. 2; pp. 407 - 418 |
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| Main Authors: | , , , , , , , , |
| Format: | Journal Article |
| Language: | English |
| Published: |
United States
International Anesthesia Research Society
01-02-2014
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| Subjects: | |
| Online Access: | Get full text |
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| Summary: | 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 disorder on postoperative complications and resource utilization in the orthopedic population. With an increasing number of surgical patients suffering from SA, this information is important to physicians, patients, policymakers, and administrators alike.
We analyzed hospital discharge data of patients who underwent total hip or knee arthroplasty in approximately 400 U.S. Hospitals between 2006 and 2010. Patient, procedure, and health care system-related demographics and outcomes such as mortality, complications, and resource utilization were compared among groups. Multivariable logistic regression models were fit to assess the association between SA and various outcomes.
We identified 530,089 entries for patients undergoing total hip and knee arthroplasty. Of those, 8.4% had a diagnosis code for SA. In the multivariate analysis, the diagnosis of SA emerged as an independent risk factor for major postoperative complications (OR 1.47; 95% confidence interval [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 receive ventilatory support, use more intensive care, stepdown and telemetry services, consume more economic resources, and have longer lengths of hospitalization.
The presence of SA is 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 to aid in the allocation of clinical and economic resources. |
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| Bibliography: | Role: This author helped design the study and write the manuscript Attestation: Roop Kaw has seen the original study data, reviewed the analysis of the data, and approved the final manuscript Role: This author helped design the study, conduct the study, and write the manuscript Conflicts: Ottokar Stundner reported no conflicts of interest Attestation: Xuming Sun has seen the original study data, reviewed the analysis of the data, and approved the final manuscript Conflicts: Peter Fleischut reported no conflicts of interest Attestation: Madhu Mazumdar has seen the original study data, reviewed the analysis of the data, and approved the final manuscript Roop Kaw Attestation: Stavros G Memtsoudis has seen the original study data, reviewed the analysis of the data, approved the final manuscript, and is the author responsible for archiving the study files Conflicts: Madhu Mazumdar reported no conflicts of interest Attestation: Peter Fleischut has seen the original study data, reviewed the analysis of the data, and approved the final manuscript Rehana Rasul Role: This author helped conduct the study, analyze the data, and write the manuscript Ottokar Stundner, MD current affiliation: Department of Anesthesiology and Intensive Care, Paracelsus Medical University, Muellner Hauptstrasse 48, 5020 Salzburg, Austria Role: This author helped analyze the data and write the manuscript Attestation: Satya-Krishna Ramachandran has seen the original study data, reviewed the analysis of the data, and approved the final manuscript Conflicts: Roop Kaw reported no conflicts of interest Conflicts: Rehana Rasul reported no conflicts of interest Satya-Krishna Ramachandran Conflicts: Xuming Sun reported no conflicts of interest Stavros G Memtsoudis Attestation: Rehana Rasul has seen the original study data, reviewed the analysis of the data, and approved the final manuscript Conflicts: Stavros G Memtsoudis reported no conflicts of interest Attestation: Ottokar Stundner has seen the original study data, reviewed the analysis of the data, and approved the final manuscript Role: This author helped design the study, analyze the data, and write the manuscript Attestation: Ya-Lin Chiu has seen the original study data, reviewed the analysis of the data, and approved the final manuscript Madhu Mazumdar Conflicts: Ya-Lin Chiu reported no conflicts of interest Ottokar Stundner Conflicts: Satya-Krishna Ramachandran reported no conflicts of interest Ya-Lin Chiu Role: This author helped design the study, conduct the study, and analyze the data Xuming Sun Institution: Department of Anesthesiology, Hospital for Special Surgery; Division of Biostatistics and Epidemiology, Department of Public Health, Weill Medical College of Cornell University Peter Fleischut Role: This author helped design the study, conduct the study, analyze the data, and write the manuscript |
| ISSN: | 0003-2999 1526-7598 |
| DOI: | 10.1213/ANE.0000000000000051 |