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The Impact of Sleep Apnea on Postoperative Utilization of Resources and Adverse Outcomes

Memtsoudis, Stavros G. MD, PhD, FCCP*†; Stundner, Ottokar MD*; Rasul, Rehana MA, MPH; Chiu, Ya-Lin MS; Sun, Xuming MS; Ramachandran, Satya-Krishna MD; Kaw, Roop MD§; Fleischut, Peter MD; Mazumdar, Madhu MS, MA, PhD

doi: 10.1213/ANE.0000000000000051
Economics, Education, and Policy: Research Report
Continuing Medical Education

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.

Accepted for publication October 18, 2013.

Ottokar Stundner, MD, is currently affiliated with Department of Anesthesiology and Intensive Care, Paracelsus Medical University, Salzburg, Austria.

Funding: This study was performed with funds from the Hospital for Special Surgery, Department of Anesthesiology, New York, NY, and the Anna-Maria and Stephen Kellen Physician-Scientist Career Development Award, New York, NY, (SGM). Contribution of RR, YLC, XS, and MM on this project was supported, in part, by funds from the Clinical Translational Science Center (CTSC), National Center for Advancing Translational Sciences (NCATS) grant # UL1-RR024996 and Center for Education, Research, and Therapeutics (CERTs), Agency for Healthcare Research and Quality (AHRQ) grant # U18 HSO16-75. The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding sources NCATS and AHRQ based in Rockville, MD.

The authors declare no conflicts of interest.

This report was previously presented, in part, at the Postgraduate Assembly (New York State Society of Anesthesiologists), December 2012, New York, NY.

Reprints will not be available from the authors

Address correspondence to Stavros G. Memtsoudis, MD, PhD, FCCP, Department of Anesthesiology, Hospital for Special Surgery, 535 East 70th St., New York, NY 10021. Address e-mail to

© 2014 International Anesthesia Research Society