Ho George, Cozowicz Crispiana, Wong Jean, Singh Mandeep, Lam Enoch, Mörwald Eva E, Hasan Najia, Memtsoudis Stavros G, Chung Frances
Department of Anesthesiology and Pain Medicine, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.
Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
BMC Anesthesiol. 2018 Sep 12;18(1):128. doi: 10.1186/s12871-018-0594-5.
Screening and optimizing patients for OSA in the perioperative period may reduce postoperative complications. However, sleep studies can be difficult to obtain before surgery. Previous surveys reported that the majority of sleep physicians would delay surgery to diagnose and manage OSA, but most anesthesiologists would not. While disagreements exist, the importance of shared decision making and patient preferences have never been studied on this topic. It is unknown whether patients with suspected OSA, when given information about OSA, would be willing to delay surgery to diagnose and manage their condition preoperatively.
This study consisted of a self-administered questionnaire that surveyed patients, patient relatives, or any accompanying members. The survey was conducted in the preoperative clinic or in the perioperative patient and family waiting area at two hospitals in Canada and in the United States. A hypothetical scenario was used: participants were given information about OSA, and asked about their preferences regarding preoperative management should they be at risk for OSA in the setting of pending elective surgery. The objective of this study was to determine whether respondents preferred to 1) proceed with surgery as planned, 2) delay surgery to ensure the medical condition of OSA is diagnosed and optimized, or 3) let his/her physician decide.
The final survey contained 19 questions and the survey was conducted from June 2016 to September 2016. Four hundred and seventy-three surveys were collected. Forty-four percent of respondents, when given information about OSA, preferred to delay surgery pending a sleep study and treatment. Forty percent of respondents who preferred to delay surgery would tolerate delaying up to two months.
Increasing emphasis and significant value has been placed on shared-decision making between patients and physicians. Educating patients about the risks of OSA and incorporating patient preferences into the perioperative management of OSA may be warranted.
在围手术期对阻塞性睡眠呼吸暂停（OSA）患者进行筛查和优化管理，可能会减少术后并发症。然而，术前很难进行睡眠研究。此前的调查显示，大多数睡眠医学医生会推迟手术以诊断和治疗OSA，但大多数麻醉医生不会。尽管存在分歧，但关于共同决策的重要性以及患者偏好，在这个问题上从未有过研究。目前尚不清楚疑似OSA的患者在得知OSA相关信息后，是否愿意推迟手术以在术前诊断和治疗其病情。
本研究采用自行填写的问卷，对患者、患者亲属或任何陪同人员进行调查。调查在加拿大和美国的两家医院的术前门诊或围手术期患者及家属等候区进行。采用了一个假设情景：向参与者提供有关OSA的信息，并询问他们在等待择期手术且有OSA风险的情况下，对术前管理的偏好。本研究的目的是确定受访者是否更倾向于：1）按计划进行手术；2）推迟手术以确保诊断和优化OSA病情；3）让其医生决定。
最终调查问卷包含19个问题，调查于2016年6月至2016年9月进行。共收集到473份调查问卷。44%的受访者在得知OSA相关信息后，更倾向于推迟手术，等待睡眠研究和治疗。40%倾向于推迟手术的受访者能够接受最多推迟两个月。
患者与医生之间的共同决策越来越受到重视且具有重要价值。有必要对患者进行OSA风险教育，并将患者偏好纳入OSA的围手术期管理。
