Sleep Disorders: Sleep Disorders 1 |

The Impact of OSA on Length of Stay and Transitions of Care in Post-Surgical Orthopedic Patients FREE TO VIEW

Radu Postelnicu, MD; Vikramjit Mukherjee, MD; Jonathan Mendelson, MD; Bishoy Zakhary, MD; Ezra Dweck, MD
Author and Funding Information

New York University, New York, NY

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):1273A. doi:10.1016/j.chest.2016.08.1387
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SESSION TITLE: Sleep Disorders 1

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM

PURPOSE: Obstructive sleep apnea (OSA) has been linked to higher rates of post-operative complications and increased length of stay. This study was performed to compare the impact of obstructive sleep apnea on post-operative orthopedic patients.

METHODS: This retrospective analysis evaluated 740 patients who underwent same-day admission for orthopedic surgical intervention from January 2014 to September 2015. The hospital medical records were reviewed to collect demographic, length of stay, and surgical information. Discharge diagnosis codes were used to define patients with OSA. Patients were matched based on sex, age, Medicare Severity Diagnosis Related Groups (MS-DRG) that defined the diagnoses and the procedures that occurred, and their discharge disposition. The hospitalization was grouped into “simple” for patients that had a de-escalation of level of care until discharge, and “complex” for patients that had an initial de-escalation of level of care and then increased to a higher level of care before discharge (such as admission to an Intensive Care Unit or Step-Down Unit). Length of stay (LOS) data were collected for each patient encounter.

RESULTS: 740 patients were matched into our analysis. 370 patients were diagnosed with OSA, and 370 did not carry this diagnosis. The average LOS for non-OSA patients was 2.93 days, and 2.82 days for OSA patients (p=0.518). Transitions of care that were categorized as “simple” had a LOS of 2.73 days in non-OSA patients, and 2.65 days in OSA patients (p=0.543). “Complex” transitions of care resulted in a LOS of 4.25 days in non-OSA patients and 3.96 days in OSA patients (p=0.514).

CONCLUSIONS: When compared to other surgical data, we show that obstructive sleep apnea in our orthopedic population does not affect the overall LOS. Additionally, unanticipated escalation of care did not reveal any differences between patients with and without OSA. To the best of our knowledge, our study is the largest to date using MS-DRG data on matched OSA patients to compare LOS following surgery.

CLINICAL IMPLICATIONS: At our institution, patients undergoing orthopedic surgery have a similar LOS irrespective of OSA diagnosis. Additionally, the effects of OSA does not appear to have an impact on LOS if there are transitions or escalations of care.

DISCLOSURE: The following authors have nothing to disclose: Radu Postelnicu, Vikramjit Mukherjee, Jonathan Mendelson, Bishoy Zakhary, Ezra Dweck

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