Original Research: Sleep Disorders |

Sleep-Disordered Breathing and Postoperative Outcomes After Elective SurgerySleep-Disordered Breathing and Operative Outcomes: Analysis of the Nationwide Inpatient Sample

Babak Mokhlesi, MD, FCCP; Margaret D. Hovda, MD; Benjamin Vekhter, PhD; Vineet M. Arora, MD; Frances Chung, MD; David O. Meltzer, MD, PhD
Author and Funding Information

From the Sleep Disorders Center (Drs Mokhlesi and Hovda), Section of Pulmonary and Critical Care; Center for Health and Social Sciences (Drs Vekhter, Arora, and Meltzer); Section of General Internal Medicine (Dr Arora); and Section of Hospital Medicine (Dr Meltzer), Department of Medicine, The University of Chicago, Chicago, IL; and the Department of Anesthesia (Dr Chung), University Health Network, University of Toronto, Toronto, ON, Canada.

Correspondence to: Babak Mokhlesi, MD, FCCP, Sleep Disorders Center, Section of Pulmonary and Critical Care, Department of Medicine, The University of Chicago, 5841 S Maryland Ave, MC6076, Chicago, IL 60637; e-mail: bmokhles@medicine.bsd.uchicago.edu

Funding/Support: This study was supported by The University of Chicago Institute for Translational Medicine and the Clinical and Translational Science Awards program [UL1 RR024999]. Dr Arora is supported by National Institute on Aging [K23 AG033763]. Dr Meltzer is supported by a Midcareer Career Development Award from the National Institutes of Health [1 K24 AG031326-01].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.

Chest. 2013;144(3):903-914. doi:10.1378/chest.12-2905
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Background:  Systematic screening and treatment of sleep-disordered breathing (SDB) or obstructive sleep apnea (OSA) in presurgical patients would impose a significant cost burden; therefore, it is important to understand whether SDB is associated with worse postoperative outcomes. We sought to determine the impact of SDB on postoperative outcomes in patients undergoing four specific categories of elective surgery (orthopedic, prostate, abdominal, and cardiovascular). The primary outcomes were in-hospital death, total charges, and length of stay (LOS). Two secondary outcomes of interest were respiratory and cardiac complications.

Methods:  Data were obtained from the Nationwide Inpatient Sample database. Regression models were fitted to assess the independent association between SDB and the outcomes of interest.

Results:  The cohort included 1,058,710 hospitalized adult patients undergoing elective surgeries between 2004 and 2008. SDB was independently associated with decreased mortality in the orthopedic (OR, 0.65; 95% CI, 0.45-0.95; P = .03), abdominal (OR, 0.38; 95% CI, 0.22-0.65; P = .001), and cardiovascular surgery groups (OR, 0.54; 95% CI, 0.40-0.73; P < .001) but had no impact on mortality in the prostate surgery group. SDB was independently associated with a small, but statistically significant increase in estimated mean LOS by 0.14 days (P < .001) and estimated mean total charges by $860 (P < .001) in the orthopedic surgery group but was not associated with increased LOS or total charges in the prostate surgery group. In the abdominal and cardiovascular surgery groups, SDB was associated with a significant decrease in adjusted mean LOS of 1.1 days and 0.35 days, respectively (P < .001 for both groups), and adjusted mean total charges of $3,814 and $4,592, respectively (P < .001 for both groups). SDB was independently associated with a significantly increased OR for emergent intubation and mechanical ventilation, noninvasive ventilation, and atrial fibrillation in all four surgical categories. Emergent intubation occurred significantly earlier in the postoperative course in patients with SDB. In the subgroup of patients requiring emergent intubation, LOS, total charges, pneumonias, and in-hospital death were significantly higher in those without SDB.

Conclusions:  In this large national study, despite the increased independent association of SDB with postoperative cardiopulmonary complications, the diagnosis of SDB was not independently associated with an increased rate of in-hospital death. SDB had a mixed impact on LOS and total charges by surgical category.

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