Healthcare utilization after elective surgery in patients with obstructive sleep apnea – analysis of a nationwide data set

Highlights

• The presence of OSA did not increase post elective surgical length of stay and mortality.

• OSA cohort was associated with increased co-morbidities, including cardiovascular disease, atrial fibrillation, stroke, and diabetes.

• The presence of OSA was associated with long-term health care utilization.

Abstract

Background

Obstructive sleep apnea is prevalent among those undergoing elective surgery and likely introduces a risk of adverse outcomes. To understand its impact, we aimed to compare healthcare utilization in postsurgical patients with obstructive sleep apnea compared to controls matched on the surgical care environment.

Methods

This is a retrospective case–control cohort study using a nationwide database. Among patients undergoing elective surgical procedures during 2009–2014, we compared patients with obstructive sleep apnea with those without obstructive sleep apnea. The two cohorts were matched based on age, sex, type of surgery, performing surgeon, the hospital where the procedure was performed, and various All-Patient-Refined Diagnosis-Related-Groups severity indices. The primary effect of interest was short-term healthcare utilization. We also compared long-term hospital admissions, intensive care unit admissions, emergency room visits and outpatient visits.

Results

47,719 subjects and controls were matched on a 1:1 basis. As the subjects were matched, the two groups did not differ on age, percent female, and various Diagnosis-Related-Groups severity indices. The obstructive sleep apnea group had more comorbid conditions and a higher Elixhauser index. Short-term healthcare utilization measured by the length of stay and mortality related to index procedure did not increase in the sleep apnea group. In hierarchical logistical regression analysis, the presence of sleep apnea predicted higher long-term health care utilization.

Conclusions

Our data suggests that the presence of sleep apnea was not associated with increased post elective surgical length of stay and mortality; however, the presence of obstructive sleep apnea was associated with long-term health care utilization.

Introduction

Obstructive sleep apnea prevalence among patients undergoing elective surgery is estimated to be approximately 25%, and in high-risk populations such as bariatric surgery patients, it can be as high as 80% [1]. The upper airway patency is compromised during sleep in obstructive sleep apnea. This may be further exacerbated by the use of anesthesia during surgical procedures. OSA, like many other chronic medical conditions may introduce risk for adverse outcomes during the surgery and post-operative period [2]. Because of this concern, the American Society of Anesthesiology issued guidelines to provide closer perioperative monitoring for patients with OSA [3,4].

Several studies have explored the impact of OSA as a chronic medical condition on mortality and health care utilization after an elective surgical procedure [[5], [6], [7]]. However, the outcomes of surgical procedures vary significantly by many factors such as patient characteristics, operating surgeon and the hospital environment. To account for the role of these complex elective surgical related factors on the OSA related outcomes, we conducted this research. In this study utilizing an extensive database, we matched the patients with OSA (with those without) by demographics, surgical care environment, and severity of the illness to compare the two groups in a more equitable fashion.

This study's primary objective was to compare short term healthcare utilization among patients with OSA undergoing elective surgery with those without OSA by matching various relevant variables.