Sleep Apnea Patients at Increased Risk for Perioperative Pulmonary Complications

Emma Hitt, PhD

January 10, 2011

January 10, 2011 — In patients with sleep apnea, perioperative pulmonary complications after orthopaedic and general surgery are significantly more frequent vs matched samples without sleep apnea, according to new research.

Stavros Memtsoudis, MD, with the Weill Medical College of Cornell University, in New York, NY, and colleagues reported their findings in the January 2011 issue of Anesthesia & Analgesia.

Sleep apnea increased the risk for perioperative tracheal intubation and mechanical ventilation by 5-fold after orthopaedic surgery and doubled the risk after general surgical procedures, the researchers report.

The current study of data from the National Inpatient Sample database was designed to compare perioperative pulmonary outcomes in patients with sleep apnea vs matched control participants and included 3,441,262 general surgery entries and 2,610,441 orthopaedic surgery entries collected between 1998 and 2007. Sleep apnea was diagnosed at a frequency of 2.52% and 1.40% for the 2 surgery types, respectively.

Patients with sleep apnea were significantly more likely to experience perioperative complications after both orthopaedic and general surgical procedures, with odds ratios (ORs) for aspiration pneumonia of 1.41 (95% confidence interval [CI], 1.35 - 1.47) and 1.37 (95% CI, 1.33 - 1.41), respectively.

For adult respiratory distress syndrome (ARDS), the ORs were 2.39 (95% CI, 2.28 - 2.51) and 1.58 (95% CI, 1.54 - 1.62), respectively. For pulmonary embolism, the ORs were 1.22 (95% CI, 1.15 - 1.29) and 0.90 (95% CI, 0.84 - 0.97), respectively; and for intubation/mechanical ventilation, the ORs were 5.20 (95% CI, 5.05 - 5.37) and 1.95 (95% CI, 1.91 - 1.98), respectively.

Furthermore, with the exception of pulmonary embolism, which was more frequent in patients with sleep apnea who underwent orthopaedic procedures (0.51% vs 0.42%; P = .0038) but not general surgical procedures (0.45% vs 0.49%; P = .22), perioperative complications were significantly more common among patients with sleep apnea for both general and orthopaedic surgery vs matched control participants (aspiration pneumonia: 1.18% vs 0.84% and 2.79% vs 2.05%, respectively; ARDS: 1.06% vs 0.45% and 3.79% vs 2.44%, respectively; and intubation/mechanical ventilation: 3.99% vs 0.79% and 10.8% vs 5.94%, respectively; all P < .0001).

"[U]sing a large nationally representative database, we identified SA [sleep apnea] as a risk factor for a number of pulmonary complications after orthopaedic and general surgical procedures, thus providing a basis for an increase in the utilization of resources, including intensive monitoring and development of strategies to prevent and treat these events," Dr. Memtsoudis and colleagues conclude.

"Findings from this analysis may be used to design research projects to elucidate the mechanism and design interventions to reduce the risk of pulmonary complications among patients with SA undergoing surgery," they add.

The study was funded by the Hospital for Special Surgery Anesthesiology Young Investigator Award provided by the Department of Anesthesiology at the Hospital for Special Surgery, Center for Education and Research in Therapeutics and Clinical Translational Science Center. The study authors have disclosed no relevant financial relationships.

Anesth Analg. 2011;112:113-121. Abstract

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