title: Sleep-disordered breathing and postoperative outcomes after elective surgery: analysis of the nationwide inpatient sample.
abstract: 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 &lt; .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 &lt; .001) and estimated mean total charges by $860 (P &lt; .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 &lt; .001 for both groups), and adjusted mean total charges of $3,814 and $4,592, respectively (P &lt; .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.
authors.affiliation: Sleep Disorders Center, Section of Pulmonary and Critical Care, Chicago, IL. Electronic address: bmokhles@medicine.bsd.uchicago.edu.
authors.forename: Babak
authors.initials: B
authors.lastname: Mokhlesi
authors.affiliation: Sleep Disorders Center, Section of Pulmonary and Critical Care, Chicago, IL.
authors.forename: Margaret D
authors.initials: MD
authors.lastname: Hovda
authors.affiliation: Center for Health and Social Sciences, Chicago, IL.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Vekhter
authors.affiliation: Center for Health and Social Sciences, Chicago, IL; Section of General Internal Medicine, Chicago, IL.
authors.forename: Vineet M
authors.initials: VM
authors.lastname: Arora
authors.affiliation: Department of Anesthesia, University Health Network, University of Toronto, Toronto, ON, Canada.
authors.forename: Frances
authors.initials: F
authors.lastname: Chung
authors.affiliation: Center for Health and Social Sciences, Chicago, IL; Section of Hospital Medicine, Department of Medicine, The University of Chicago, Chicago, IL.
authors.forename: David O
authors.initials: DO
authors.lastname: Meltzer
mesh_terms: D000328:Adult; D017558:Elective Surgical Procedures; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015994:Incidence; D007297:Inpatients / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000639:trends; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies; D012891:Sleep Apnea Syndromes / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D014481:United States / Q000453:epidemiology
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