CPAP in OSA patients and post-operative outcomes
Aljasmi M, Uduman A, Gashouta M, Wong H, Bazan L, Mordis C, Roehrs T. CPAP in OSA patients and post-operative outcomes. Chest 2016; 150(4):1279A.
PURPOSE: Over half of the patients with OSA who present for surgery are undiagnosed and untreated. The incidence of perioperative complications is greater in patients with OSA. Patients with OSA are at higher risk for complications from procedures with sedation, analgesia, and anesthesia. Adverse events include respiratory complications, postoperative cardiac events, and transfer to the intensive care unit. Our aim was to determine whether identifying and treating patients with OSA prior to surgery reduced adverse events 6 months postoperatively. METHODS: We performed a retrospective chart review of 90 patients that underwent elective surgery at Henry Ford Hospital with a STOPBANG score of 6 or greater (signifying higher risk for OSA). We excluded patients with New York Heart Association III-IV heart failure, severe chronic obstructive pulmonary disease, neuromuscular disease, and drug or alcohol abuse. The primary endpoint of the study were the number of complications from the date of surgery to 6 months postoperatively. These endpoints include 30-day mortality, re-admission, re-intubations, pneumonia, myocardial infarction, ICU transfers, delirium, wound healing and venous thromboembolism (VTE). Kruskal-Wallis and t-test statistical analysis were performed. RESULTS: Fifty patients diagnosed with OSA and treated with CPAP were included in the treatment group and 40 patients with a STOP-BANG score of 6 or greater and not on CPAP therapy were included in the non-treatment group. The two groups were similar in regards to race, ethnicity, co-morbid conditions, STOP-BANG score, age, ASA score, and BMI. No significant statistical difference was found in regards to the primary outcome in the first 30 post-operative days. Three patients developed venous thromboembolism (VTE) in the untreated group (8%) as compared to the treatment group (X2=3.94, p<.05). The pre-surgery VTE risk did not differ between treated and untreated. Based on the Caprini VTE risk assessment score patient whom developed VTE had a higher risk score (score of 7) while the patients who were not diagnosed with VTE had a mean risk score of 5.72. CONCLUSIONS: Patients with OSA that are not treated with CPAP demonstrate a higher risk for VTE postoperatively. This stresses the importance of early diagnosis and treatment of OSA prior to scheduled elective surgery.