Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada.
Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada; Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, ON, Canada.
J Clin Anesth. 2024 Sep;96:111464. doi: 10.1016/j.jclinane.2024.111464. Epub 2024 May 7.
The suitability of ambulatory surgery for patients with obstructive sleep apnea (OSA) remains controversial. This systematic review and meta-analysis aimed to evaluate the odds of perioperative adverse events in patients with OSA undergoing ambulatory surgery, compared to patients without OSA.
Four electronic databases were searched for studies published between January 1, 2011 and July 11, 2023. The inclusion criteria were: adult patients with diagnosed or high-risk of OSA undergoing ambulatory surgery; perioperative adverse events; control group included; general and/or regional anesthesia; and publication on/after February 1, 2011. We calculated effect sizes as odds ratios using a random effects model, and additional sensitivity analyses were conducted.
Seventeen studies (375,389 patients) were included. OSA was associated with an increased odds of same-day admission amongst all surgery types (OR 1.94, 95% CI 1.46-2.59, I:79%, P < 0.00001, 11 studies, n = 347,342), as well as when only orthopedic surgery was considered (OR 2.68, 95% CI 2.05-3.48, I:41%, P < 0.00001, 6 studies, n = 132,473). Three studies reported that OSA was strongly associated with prolonged post anesthesia care unit (PACU) length of stay (LOS), while one study reported that the association was not statistically significant. In addition, four studies reported that OSA was associated with postoperative respiratory depression/hypoxia, with one large study on shoulder arthroscopy reporting an almost 5-fold increased odds of pulmonary compromise, 5-fold of myocardial infarction, 3-fold of acute renal failure, and 5-fold of intensive care unit (ICU) admission.
Ambulatory surgical patients with OSA had almost two-fold higher odds of same-day admission compared to non-OSA patients. Multiple large studies also reported an association of OSA with prolonged PACU LOS, respiratory complications, and/or ICU admission. Clinicians should screen preoperatively for OSA, optimize comorbidities, adhere to clinical algorithm-based management perioperatively, and maintain a high degree of vigilance in the postoperative period.
对于阻塞性睡眠呼吸暂停（OSA）患者，门诊手术的适用性仍存在争议。本系统评价和荟萃分析旨在评估 OSA 患者在接受门诊手术时发生围手术期不良事件的几率，与无 OSA 患者进行比较。
检索了 2011 年 1 月 1 日至 2023 年 7 月 11 日期间发表的四项电子数据库中的研究。纳入标准为：接受诊断或 OSA 高风险的门诊手术的成年患者；围手术期不良事件；对照组包括；全身和/或区域麻醉；以及在 2011 年 2 月 1 日或之后发表的研究。我们使用随机效应模型计算了效应大小作为比值比，并进行了额外的敏感性分析。
纳入了 17 项研究（375,389 名患者）。对于所有手术类型，OSA 与当日住院的几率增加相关（OR 1.94，95%CI 1.46-2.59，I：79%，P<0.00001，11 项研究，n=347,342），而仅考虑骨科手术时也是如此（OR 2.68，95%CI 2.05-3.48，I：41%，P<0.00001，6 项研究，n=132,473）。三项研究报告称，OSA 与麻醉后护理单元（PACU）住院时间延长强烈相关，而一项研究报告称，这种关联无统计学意义。此外，四项研究报告称，OSA 与术后呼吸抑制/缺氧有关，一项关于肩关节镜检查的大型研究报告称，肺功能受损的几率增加近 5 倍，心肌梗死增加 5 倍，急性肾衰竭增加 3 倍，重症监护病房（ICU）入住增加 5 倍。
与非 OSA 患者相比，接受门诊手术的 OSA 患者当日住院的几率几乎增加了两倍。多项大型研究还报告称，OSA 与 PACU LOS 延长、呼吸并发症和/或 ICU 入院有关。临床医生应在术前筛查 OSA，优化合并症，在围手术期遵循基于临床算法的管理，并在术后保持高度警惕。
