PURPOSE: Obstructive sleep apnea(OSA) is underrecognized in the pre-operative(pre-op) period and adverse surgical events appear to be more frequent in OSA patients. The purpose of our study was to determine if increased body mass index(BMI) which is associated with OSA may have had an influence in the early death of surgical patients during the post-operative(post-op) period.
METHODS: Retrospective chart review of surgical patients who expired during 2004-2005 at our institution. Patients with a BMI>25(overweight, obese and morbidly obese) and those with a BMI≤25(healthy and underweight) were compared to their time of death in relationship to surgery. Time of death was defined as the early period if it happened within the first 7 post-op days and late period if more than 7 days. Additional analysis included desaturation events(DEs) during the pre-op/peri-operative(peri-op)/time of death periods. Any amount of desaturations in each of these 3 time periods was considered a desaturation event(DE)(a patient could have a range of 0-3DEs). Risk factors for coronary artey disease(CAD) were obtained.
RESULTS: 44%(32/72)of expired patients had a BMI>25 and 56%(40/72) had a BMI≤25. 53%(17/32) of the patients with BMI>25 died within the early period as compared to only 32%(13/40) of patients with a BMI≤25. 75%(24/32) of patients with BMI>25 had at least 1 DE(a mean of 1.55 DEs per patient). 82%(33/40) of patients with a BMI≤25 had at least 1 DE(a mean of 1.45 DEs per patient). In the patients who died in the early period, there was an average of 2.47 CAD risk factors per patient in the BMI>25 group and 2.84 per patient in the BMI≤25 group. Only 1 patient was diagnosed previously with OSA.
CONCLUSION: Patients with BMI>25 compared to patients with BMI≤25 were more likely to die in the early period. This phenomenon is not related to DEs or CAD risk factors.
CLINICAL IMPLICATIONS: The phenomenon stated in the conclusion may possibly be related to undiagnosed OSA and further investigation is warranted. Physicians should have heightened awareness for undiagnosed OSA in the pre-op setting.
DISCLOSURE: Dorian Gomez, None.