University of Cincinnati Department of Otolaryngology-Head and Neck Surgery, Cincinnati, Ohio, USA.
Otolaryngol Head Neck Surg. 2012 Jan;146(1):156-61. doi: 10.1177/0194599811427251. Epub 2011 Oct 31.
OBJECTIVES/HYPOTHESIS: (1) To determine the presence of Veterans Affairs (VA) institutional guidelines for the perioperative management of obstructive sleep apnea (OSA); (2) to examine current use of preoperative screening tools for OSA in the VA; and (3) to understand current VA practice patterns regarding postoperative disposition of patients with OSA.
Survey study.
Veterans Affairs hospitals with surgical services; sample size 102 facilities.
Veterans Affairs health care providers.
The authors surveyed health care providers at VA hospitals using a survey tool developed by the authors.
The response rate was 80%. A variety of preoperative screening tools for OSA were used by respondents, most commonly American Society of Anesthesiologists guidelines (53%). A policy for postoperative disposition of known and presumed OSA was present in 26% and 19% of responses, respectively. Of those respondents reporting a formal postoperative care policy, 48% and 30% admitted patients to a monitored ward bed and surgical intensive care unit, respectively. Of the 74% of respondents unaware of an institutional policy, Anesthesia and Surgery worked together to dictate postoperative disposition of patients with known OSA 73% of the time. The degree of OSA was ranked as the most important factor (58%) influencing postoperative disposition. Ten percent of respondents reported a major perioperative complication attributable to OSA in the past year.
This survey study elucidates the heterogeneity of preoperative screening for and postoperative care of veterans with OSA. Future investigators may use these data to formalize institutional policies with regard to patients with OSA, with potentially significant impacts on patient care and usage of financial resources.
目的/假设：（1）确定退伍军人事务部（VA）是否有关于阻塞性睡眠呼吸暂停（OSA）围手术期管理的机构指南；（2）检查 VA 目前在 OSA 术前筛查工具的使用情况；（3）了解 VA 目前关于 OSA 术后患者处置的实践模式。
调查研究。
具有手术服务的退伍军人事务医院；样本量为 102 个设施。
退伍军人事务医疗保健提供者。
作者使用作者开发的调查工具对 VA 医院的医疗保健提供者进行了调查。
回应率为 80%。受访者使用了各种 OSA 术前筛查工具，最常用的是美国麻醉师协会指南（53%）。分别有 26%和 19%的受访者报告了针对已知和假定 OSA 的术后处置政策。在报告有正式术后护理政策的受访者中，分别有 48%和 30%的受访者将患者收治在监测病房床位和外科重症监护病房。在 74%不知道机构政策的受访者中，麻醉科和外科医生共同决定了已知 OSA 患者的术后处置，这一比例为 73%。OSA 的严重程度被列为影响术后处置的最重要因素（58%）。10%的受访者报告称，在过去一年中，有一项与 OSA 相关的重大围手术期并发症。
这项调查研究阐明了退伍军人 OSA 术前筛查和术后护理的异质性。未来的研究人员可以使用这些数据来制定关于 OSA 患者的机构政策，这可能对患者护理和财务资源的使用产生重大影响。
