title: Perioperative pulmonary outcomes in patients with sleep apnea after noncardiac surgery.
abstract: BACKGROUND
  Although patients with sleep apnea (SA) are considered to be at increased risk for postoperative complications, evidence supporting increased risk of perioperative pulmonary morbidity is limited. The objective of this study, therefore, was to analyze perioperative demographics and pulmonary outcomes of patients with SA after orthopedic and general surgical procedures using a population-based sample. We hypothesized that SA is an independent risk factor for perioperative pulmonary complications, thus providing a basis for an increase in the utilization of resources, including intensive monitoring and development of strategies to prevent and treat these events.
  
  
  METHODS
  National Inpatient Sample data for each year between 1998 and 2007 were accessed. Orthopedic and general surgical procedures were included and discharges with a diagnosis code for SA were identified. Patients with the diagnosis of SA were matched to those without the disease based on demographic variables using the propensity scoring method. Aspiration pneumonia, adult respiratory distress syndrome (ARDS), pulmonary embolism (PE), and the need for intubation and mechanical ventilation were the primary outcomes. Odds ratio (OR) and absolute risk reduction along with 95% confidence interval were reported.
  
  
  RESULTS
  We identified 2,610,441 entries for orthopedic and 3,441,262 for general surgical procedures performed between 1998 and 2007. Of those, 2.52% and 1.40%, respectively, carried a diagnosis of SA. Patients with SA developed pulmonary complications more frequently than their matched controls after both orthopedic and general surgical procedures, respectively (i.e., aspiration pneumonia: 1.18% vs 0.84% and 2.79% vs 2.05%; ARDS: 1.06% vs 0.45% and 3.79% vs 2.44%; intubation/mechanical ventilation: 3.99% vs 0.79% and 10.8% vs 5.94%, all P values <0.0001). Comparatively, PE was more frequent in SA patients after orthopedic procedures (0.51% vs 0.42%, P = 0.0038) but not after general surgical procedures (0.45% vs 0.49%, P = 0.22). SA was associated with a significantly higher adjusted OR of developing pulmonary complications after both orthopedic and general surgical procedures, respectively, with the exception of PE (OR for aspiration pneumonia: 1.41 [1.35, 1.47] and 1.37 [1.33, 1.41]; for ARDS: 2.39 [2.28, 2.51] and 1.58 [1.54, 1.62]; for PE: OR 1.22 [1.15, 1.29] and 0.90 [0.84, 0.97]; for intubation/mechanical ventilation: 5.20 [5.05, 5.37] and 1.95 [1.91, 1.98]).
  
  
  CONCLUSIONS
  SA is an independent risk factor for perioperative pulmonary complications. Our results may be used for hypothesis generation for clinical studies targeted to improve perioperative outcomes in this patient population.
authors.affiliation: Department of Anesthesiology, Hospital for Special Surgery, Weill Medical College of Cornell University, 535 East 70th St., New York, NY 10021, USA. memtsoudiss@hss.edu
authors.forename: Stavros
authors.initials: S
authors.lastname: Memtsoudis
authors.forename: Spencer S
authors.initials: SS
authors.lastname: Liu
authors.forename: Yan
authors.initials: Y
authors.lastname: Ma
authors.forename: Ya Lin
authors.initials: YL
authors.lastname: Chiu
authors.forename: J Matthias
authors.initials: JM
authors.lastname: Walz
authors.forename: Licia K
authors.initials: LK
authors.lastname: Gaber-Baylis
authors.forename: Madhu
authors.initials: M
authors.lastname: Mazumdar
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007431:Intraoperative Complications / Q000453:epidemiology* / Q000209:etiology* / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care / Q000009:adverse effects / Q000379:methods*; D012307:Risk Factors; D012891:Sleep Apnea Syndromes / Q000150:complications* / Q000601:surgery; D016896:Treatment Outcome; D055815:Young Adult