Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota.
Kern Center for the Science of Healthcare Delivery, Mayo Clinic College of Medicine and Science, Rochester, Minnesota.
Ann Thorac Surg. 2020 Oct;110(4):1324-1332. doi: 10.1016/j.athoracsur.2019.12.082. Epub 2020 Feb 20.
Obstructive sleep apnea (OSA) is associated with increased risk of postoperative complications in noncardiac surgery, with limited literature on cardiac surgical patients. Perioperative outcomes of patients with OSA were compared with outcomes of those without OSA undergoing cardiac surgery.
This was a retrospective single-center cohort study of adults who underwent cardiac surgery from January 2010 to April 2017. Outcomes of patients with OSA were compared with those without OSA, including length of stay, readmissions, hospital death, and short-term outcomes.
OSA was present in 2636 of 8612 patients (30.6%) identified during the study period with OSA. Patients with OSA had a longer median length of stay (6 vs 5 days, P < .001), longer incidence of prolonged (>7 days) length of stay (26.3% vs 23.0%, P < .001), and were less likely to be discharged to home (78.2% vs 84.4%, P < .001). OSA patients also had a higher 30-day readmission rate (14.7% vs 10.4%, P < .001). Acute kidney injury was more common in OSA patients (25.2% vs 19.9%, P < .001). Our multivariable model found postoperative atrial fibrillation was associated with older age and not OSA status (age <50 years compared with >75 years; odds ratio, 4.10; 95% confidence interval, 3.39-4.96).
OSA patients had a longer mean length of stay, were more likely to have a prolonged length of stay, more likely to be discharged to a location other than home, and had a higher 30-day readmission rate. This suggests higher resource utilization is required to care for OSA patients after cardiac surgery.
阻塞性睡眠呼吸暂停（OSA）与非心脏手术术后并发症风险增加相关，而关于心脏手术患者的文献有限。本研究比较了患有 OSA 和不患有 OSA 的心脏手术患者的围手术期结局。
这是一项回顾性单中心队列研究，纳入了 2010 年 1 月至 2017 年 4 月期间接受心脏手术的成年人。比较了患有 OSA 和不患有 OSA 的患者的结局，包括住院时间、再入院、院内死亡和短期结局。
在研究期间，共发现 8612 例患者中有 2636 例（30.6%）患有 OSA。与不患有 OSA 的患者相比，患有 OSA 的患者的中位住院时间更长（6 天 vs 5 天，P<0.001），出现长于（>7 天）住院时间的比例更高（26.3% vs 23.0%，P<0.001），出院回家的可能性更低（78.2% vs 84.4%，P<0.001）。OSA 患者的 30 天再入院率也更高（14.7% vs 10.4%，P<0.001）。与不患有 OSA 的患者相比，OSA 患者更易发生急性肾损伤（25.2% vs 19.9%，P<0.001）。我们的多变量模型发现，术后心房颤动与年龄较大而不是 OSA 状态相关（年龄<50 岁与>75 岁相比；比值比，4.10；95%置信区间，3.39-4.96）。
患有 OSA 的患者的平均住院时间更长，出现长于（>7 天）住院时间的可能性更大，出院到家庭以外地点的可能性更大，30 天再入院率更高。这表明，心脏手术后需要更多的资源来照顾 OSA 患者。
