Department of Anesthesiology, Hospital for Special Surgery, Weill Medical College of Cornell University, 535 East 70th St., New York, NY 10021, USA.
Anesth Analg. 2011 Jan;112(1):113-21. doi: 10.1213/ANE.0b013e3182009abf. Epub 2010 Nov 16.
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.
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.
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]).
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.
尽管患有睡眠呼吸暂停（SA）的患者被认为术后并发症的风险增加，但支持围手术期肺部发病率增加的证据有限。因此，本研究的目的是使用基于人群的样本分析骨科和普通外科手术后 SA 患者的围手术期人口统计学和肺部结果。我们假设 SA 是围手术期肺部并发症的独立危险因素，从而为增加资源的利用提供了依据，包括加强监测和制定预防和治疗这些事件的策略。
访问了 1998 年至 2007 年期间的国家住院患者样本数据。纳入了骨科和普通外科手术，确定了 SA 诊断代码的出院患者。使用倾向评分法，根据人口统计学变量将 SA 诊断患者与无疾病患者进行匹配。吸入性肺炎、成人呼吸窘迫综合征（ARDS）、肺栓塞（PE）和需要插管和机械通气是主要结局。报告了比值比（OR）和绝对风险降低以及 95%置信区间。
我们确定了 1998 年至 2007 年期间进行的 2610441 例骨科手术和 3441262 例普通外科手术。其中，分别有 2.52%和 1.40%的手术携带 SA 诊断。与匹配对照组相比，患有 SA 的患者在骨科和普通外科手术后更频繁地发生肺部并发症，分别为（即吸入性肺炎：1.18%比 0.84%和 2.79%比 2.05%；ARDS：1.06%比 0.45%和 3.79%比 2.44%；插管/机械通气：3.99%比 0.79%和 10.8%比 5.94%，所有 P 值均<0.0001）。相比之下，SA 患者在骨科手术后发生 PE 的频率更高（0.51%比 0.42%，P=0.0038），但在普通外科手术后则不然（0.45%比 0.49%，P=0.22）。SA 与骨科和普通外科手术后发生肺部并发症的调整后 OR 显著相关，除了 PE（吸入性肺炎的 OR：1.41[1.35,1.47]和 1.37[1.33,1.41]；ARDS：2.39[2.28,2.51]和 1.58[1.54,1.62]；PE：OR 1.22[1.15,1.29]和 0.90[0.84,0.97]；插管/机械通气：5.20[5.05,5.37]和 1.95[1.91,1.98]）。
SA 是围手术期肺部并发症的独立危险因素。我们的结果可用于生成假设，为针对改善该患者人群围手术期结局的临床研究提供依据。
