The impact of sleep apnea on postoperative utilization of resources and adverse outcomes.
BACKGROUND
Despite the concern that sleep apnea (SA) is associated with increased risk for postoperative complications, a paucity of information is available regarding the effect of this disorder on postoperative complications and resource utilization in the orthopedic population. With an increasing number of surgical patients suffering from SA, this information is important to physicians, patients, policymakers, and administrators alike.


METHODS
We analyzed hospital discharge data of patients who underwent total hip or knee arthroplasty in approximately 400 U.S. Hospitals between 2006 and 2010. Patient, procedure, and health care system-related demographics and outcomes such as mortality, complications, and resource utilization were compared among groups. Multivariable logistic regression models were fit to assess the association between SA and various outcomes.


RESULTS
We identified 530,089 entries for patients undergoing total hip and knee arthroplasty. Of those, 8.4% had a diagnosis code for SA. In the multivariate analysis, the diagnosis of SA emerged as an independent risk factor for major postoperative complications (OR 1.47; 95% confidence interval [CI], 1.39-1.55). Pulmonary complications were 1.86 (95% CI, 1.65-2.09) times more likely and cardiac complications 1.59 (95% CI, 1.48-1.71) times more likely to occur in patients with SA. In addition, SA patients were more likely to receive ventilatory support, use more intensive care, stepdown and telemetry services, consume more economic resources, and have longer lengths of hospitalization.


CONCLUSIONS
The presence of SA is a major clinical and economic challenge in the postoperative period. More research is needed to identify SA patients at risk for complications and develop evidence-based practices to aid in the allocation of clinical and economic resources.
From the Department of Anesthesiology, Hospital for Special Surgery, Division of Biostatistics and Epidemiology, Department of Public Health, Weill Medical College of Cornell University, New York, New York; Department of Anesthesiology, University of Michigan Health System, Ann Arbor, Michigan; Department of Hospital Medicine, Cleveland Clinic, Cleveland, Ohio; and Department of Anesthesiology, NewYork-Presbyterian Hospital, Weill Medical College of Cornell University, New York, New York.
Stavros G
SG
Memtsoudis
Ottokar
O
Stundner
Rehana
R
Rasul
Ya-Lin
YL
Chiu
Xuming
X
Sun
Satya-Krishna
SK
Ramachandran
Roop
R
Kaw
Peter
P
Fleischut
Madhu
M
Mazumdar
D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000379:methods*; D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D015897:Comorbidity; D016208:Databases, Factual; D005260:Female; D025981:Hip Injuries / Q000150:complications; D006801:Humans; D007718:Knee Injuries / Q000150:complications; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications; D015995:Prevalence; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D012891:Sleep Apnea Syndromes / Q000150:complications* / Q000601:surgery*; D013686:Telemetry; D016896:Treatment Outcome