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Sleep-Disordered Breathing and Postoperative OutcomesSleep-Disordered Breathing and Patient Safety: Patient Safety First! FREE TO VIEW

Ruggero M. Corso, MD; Paolo Pelosi, PhD, MD; Giuseppe Insalaco, MD, FCCP; Alberto Braghiroli, MD; Cesare Gregoretti, MD
Author and Funding Information

From the Emergency Department, Anesthesia and Intensive Care Unit (Dr Corso), “G.B. Morgagni” Hospital; Department of Surgical Sciences and Integrated Diagnostics (Dr Pelosi), University of Genoa; National Research Council of Italy - Institute of Biomedicine and Molecular Immunology (Dr Insalaco); “S. Maugeri” Foundation, I.R.C.C.S. - Dept. of Pulmonary Rehabilitation (Dr Braghiroli), Scientific Institute of Veruno; and Critical Care Medicine Department (Dr Gregoretti), “Città della salute e della scienza” Hospital.

Correspondence to: Ruggero M. Corso, MD, Morgagni-Pierantoni Hospital, Anesthesia, Viale Forlanini 34, Forlì, Italy 47100; e-mail: rmcorso@gmail.com


Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

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


Chest. 2013;144(4):1421-1422. doi:10.1378/chest.13-1342
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To the Editor:

We read with interest the article by Mokhlesi et al1 in CHEST (September 2013) on the analysis of sleep-disordered breathing (SDB) and postoperative outcomes after elective surgery. They found that despite the increased independent association of SDB with postoperative cardiopulmonary complications, the diagnosis of SDB was not independently associated with increased in-hospital death. Nevertheless, we raise some concerns about the final message given to the readers of this manuscript that should be discussed.

  • 1. The group of patients investigated in this study was not homogeneous, since the term SDB includes different sleep disorders, like central sleep apnea and obesity hypoventilation syndrome, that might differently affect postoperative cardiopulmonary complications and in-hospital mortality. Although central sleep apnea prevalence in a surgical population is still unknown, its association with heart and chronic renal failure is not negligible, possibly leading to a different risk for cardiopulmonary complications than OSA alone. However, most of the published studies and recommendations are focused on OSA only.

  • 2. Reported data values on in-hospital mortality by Mokhlesi et al1 are lower than those found in literature. A recent 7-day cohort study reported a 4% inhospital mortality rate after noncardiac surgery2. Similarly, Finks et al,3 for patients undergoing pancreatectomy, reported in the same period a range of mortality from 6.5% to 5.9% as compared with 0.5% found by Mokhlesi et al1 in the group of patients undergoing abdominal surgery. It can be hypothesized that the cohort of patients included in the Mokhlesi et al1 study, although very extensive, might not be representative of the overall surgical population, leading to a systematic undervaluation of inhospital mortality.

  • 3. The authors state that SDB disorders were not associated with increased in-hospital mortality but with a higher risk of postoperative cardiopulmonary complications,1 likely due to upper airway dysfunction.4 According to the Helsinki Declaration on Patient Safety in Anaesthesiology,5 any effort should be focused not only on reducing perioperative in-hospital mortality but also on improving long-term outcome and quality of life, as well as ensuring that the patients do not experience adverse events, such as those reported associated with SDB.

We hope that these observations further support the authors’ proposal for a large, prospective, multicenter study aimed at assessing the impact of early diagnosis and treatment of SDB on patients’ outcomes in the postoperative period. In the meantime, let’s not forget that patients’ safety comes first!

References

Mokhlesi B, Hovda MD, Vekhter B, Arora VM, Chung F, Meltzer DO. Sleep-disordered breathing and postoperative outcomes after elective surgery: analysis of the Nationwide Inpatient Sample. Chest. 2013;144(3):903-914. [CrossRef] [PubMed]
 
Pearse RM, Moreno RP, Bauer P, et al; European Surgical Outcomes Study (EuSOS) group for the Trials groups of the European Society of Intensive Care Medicine and the European Society of Anaesthesiology. Mortality after surgery in Europe: a 7 day cohort study. Lancet. 2012;380(9847):1059-1065. [CrossRef] [PubMed]
 
Finks JF, Osborne NH, Birkmeyer JD. Trends in hospital volume and operative mortality for high-risk surgery. N Engl J Med. 2011;364(22):2128-2137. [CrossRef] [PubMed]
 
Chung SA, Yuan H, Chung F. A systemic review of obstructive sleep apnea and its implications for anesthesiologists. Anesth Analg. 2008;107(5):1543-1563. [CrossRef] [PubMed]
 
Mellin-Olsen J, Staender S, Whitaker DK, Smith AF. The Helsinki declaration on patient safety in anaesthesiology. Eur J Anaesthesiol. 2010;27(7):592-597. [CrossRef] [PubMed]
 

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References

Mokhlesi B, Hovda MD, Vekhter B, Arora VM, Chung F, Meltzer DO. Sleep-disordered breathing and postoperative outcomes after elective surgery: analysis of the Nationwide Inpatient Sample. Chest. 2013;144(3):903-914. [CrossRef] [PubMed]
 
Pearse RM, Moreno RP, Bauer P, et al; European Surgical Outcomes Study (EuSOS) group for the Trials groups of the European Society of Intensive Care Medicine and the European Society of Anaesthesiology. Mortality after surgery in Europe: a 7 day cohort study. Lancet. 2012;380(9847):1059-1065. [CrossRef] [PubMed]
 
Finks JF, Osborne NH, Birkmeyer JD. Trends in hospital volume and operative mortality for high-risk surgery. N Engl J Med. 2011;364(22):2128-2137. [CrossRef] [PubMed]
 
Chung SA, Yuan H, Chung F. A systemic review of obstructive sleep apnea and its implications for anesthesiologists. Anesth Analg. 2008;107(5):1543-1563. [CrossRef] [PubMed]
 
Mellin-Olsen J, Staender S, Whitaker DK, Smith AF. The Helsinki declaration on patient safety in anaesthesiology. Eur J Anaesthesiol. 2010;27(7):592-597. [CrossRef] [PubMed]
 
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