Fiorentino Michele, Hwang Franchesca, Pentakota Sri Ram, Livingston David H, Mosenthal Anne C
Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA.
Trauma Surg Acute Care Open. 2020 Oct 9;5(1):e000529. doi: 10.1136/tsaco-2020-000529. eCollection 2020.
Obstructive sleep apnea (OSA) is increasingly prevalent in the range of 2% to 24% in the US population. OSA is a well-described predictor of pulmonary complications after elective operation. Yet, data are lacking on its effect after operations for trauma. We hypothesized that OSA is an independent predictor of pulmonary complications in patients undergoing operations for traumatic pelvic/lower limb injuries (PLLI).
Nationwide Inpatient Sample (2009-2013) was queried for International Classification of Diseases, Ninth Revision, Clinical Modification codes for PLLI requiring operation. Elective admissions and those with concurrent traumatic brain injury with moderate to prolonged loss of consciousness were excluded. Outcome measures were pulmonary complications including ventilatory support, ventilator-associated pneumonia, pulmonary embolism (PE), acute respiratory distress syndrome (ARDS), and respiratory failure. Multivariable logistic regression analysis was used, adjusting for OSA, age, sex, race/ethnicity, and specific comorbidities (obesity, chronic lung disease, and pulmonary circulatory disease). P<0.01 was considered statistically significant.
Among the 337 333 patients undergoing PLLI operation 3.0% had diagnosed OSA. Patients with OSA had more comorbidities and were more frequently discharged to facilities. Median length of stay was longer in the OSA group (5 vs 4 days, p<0.001). Pulmonary complications were more frequent in those with OSA. Multivariable logistic regression showed that OSA was an independent predictor of ventilatory support (adjusted odds ratio (aOR), 1.37; 95% CI,1.24 to 1.51), PE (aOR 1.40; 95% CI, 1.15 to 1.70), ARDS (aOR 1.36; 95% CI,1.23 to 1.52), and respiratory failure (aOR 1.90; 95% CI, 1.74 to 2.06).
OSA is an independent and underappreciated predictor of pulmonary complications in those undergoing emergency surgery for PLLI. More aggressive screening and identification of OSA in trauma patients undergoing operation are necessary to provide closer perioperative monitoring and interventions to reduce pulmonary complications and improve outcomes.
Prognostic Level IV.
阻塞性睡眠呼吸暂停（OSA）在美国人群中的患病率日益增加，范围在2%至24%之间。OSA是择期手术后肺部并发症的一个已被充分描述的预测指标。然而，关于其在创伤手术后的影响的数据却很缺乏。我们假设OSA是接受创伤性骨盆/下肢损伤（PLLI）手术患者肺部并发症的一个独立预测指标。
查询全国住院患者样本（2009 - 2013年）中需要手术的PLLI的国际疾病分类第九版临床修订编码。排除择期入院患者以及伴有中度至长期意识丧失的并发创伤性脑损伤患者。结局指标为肺部并发症，包括通气支持、呼吸机相关性肺炎、肺栓塞（PE）、急性呼吸窘迫综合征（ARDS）和呼吸衰竭。采用多变量逻辑回归分析，对OSA、年龄、性别、种族/民族以及特定合并症（肥胖、慢性肺病和肺循环疾病）进行校正。P<0.01被认为具有统计学意义。
在337333例接受PLLI手术的患者中，3.0%被诊断为OSA。OSA患者合并症更多，且更频繁地被转至其他机构。OSA组的中位住院时间更长（5天对4天，p<0.001）。OSA患者肺部并发症更常见。多变量逻辑回归显示，OSA是通气支持（校正比值比（aOR），1.37；95%可信区间，1.24至1.51）、PE（aOR 1.40；95%可信区间，1.15至1.70）、ARDS（aOR 1.36；95%可信区间，1.23至1.5）和呼吸衰竭（aOR 1.90；95%可信区间，1.74至2.06）的独立预测指标。
OSA是接受PLLI急诊手术患者肺部并发症的一个独立且未得到充分认识的预测指标。有必要对接受手术的创伤患者进行更积极的OSA筛查和识别，以提供更密切的围手术期监测和干预措施，减少肺部并发症并改善结局。
预后IV级。
