Institute for Healthcare Delivery Science, Department of Population Health Science & Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Department of Anesthesiology, Hospital for Special Surgery, New York, NY, USA; Department of Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University, Salzburg, Austria.
Sleep Med. 2019 Apr;56:117-122. doi: 10.1016/j.sleep.2019.01.021. Epub 2019 Jan 29.
Although obstructive sleep apnea (OSA) is a known risk factor for perioperative complications in various patient cohorts data is lacking for patients undergoing hysterectomies, one of the most frequently performed surgeries among women. Using national data we therefore aimed to assess the risk in this patient group.
We extracted data on patients who underwent a hysterectomy between 2006 and 2014 from a large nationwide database (n = 459,508). OSA patients (identified by ICD-9 CM codes) were compared to non-OSA patients regarding perioperative outcomes: cardiac, central-nervous, gastrointestinal, genitourinary, renal, respiratory, and thromboembolic complications; as well as opioid prescription, need for blood transfusion, cost of hospitalization, length of stay and ICU admission. Odds ratios (OR) and 95% confidence intervals (CI) are reported.
Overall, 2.67% (n = 11,936) of patients were identified as having OSA. Compared to non-OSA patients, OSA was particularly associated with higher odds for renal (OR 1.98; 95% CI 1.70-2.32) and respiratory complications (OR 3.25; 95% CI 2.97-3.56), and ICU admission (OR 2.28; 95% CI 1.77-2.94). Further, while significant, OSA was associated with modestly increased cost of hospitalization (+6.24%; P < 0.0001) and length of stay (+2.58%; P < 0.0001).
In patients undergoing hysterectomies, OSA was associated with substantially increased risk of complications and modestly increased resource utilization. Further research is needed to assess currently used perioperative care strategies for OSA patients undergoing hysterectomies, with the goal to improve outcomes.
尽管阻塞性睡眠呼吸暂停（OSA）是各种患者群体围手术期并发症的已知危险因素，但在女性中最常进行的手术之一——子宫切除术患者中，数据却有所缺乏。因此，我们使用全国性数据来评估该患者群体的风险。
我们从一个大型全国性数据库中提取了 2006 年至 2014 年间接受子宫切除术的患者数据（n=459508）。通过国际疾病分类第 9 版临床修正代码（ICD-9 CM 代码）识别 OSA 患者，并将其与非 OSA 患者的围手术期结果进行比较：心脏、中枢神经系统、胃肠道、泌尿生殖系统、肾脏、呼吸系统和血栓栓塞并发症；以及阿片类药物处方、输血需求、住院费用、住院时间和 ICU 入院。报告了比值比（OR）和 95%置信区间（CI）。
总体而言，2.67%（n=11936）的患者被确定为患有 OSA。与非 OSA 患者相比，OSA 与更高的肾脏（OR 1.98；95%CI 1.70-2.32）和呼吸系统并发症（OR 3.25；95%CI 2.97-3.56）以及 ICU 入院（OR 2.28；95%CI 1.77-2.94）的几率相关。此外，尽管具有统计学意义，但 OSA 与住院费用适度增加（+6.24%；P<0.0001）和住院时间延长（+2.58%；P<0.0001）相关。
在接受子宫切除术的患者中，OSA 与并发症风险显著增加和资源利用适度增加相关。需要进一步研究评估目前用于接受子宫切除术的 OSA 患者的围手术期护理策略，以改善结局。
