Chen I-Wen, Chang Li-Chen, Wu Jheng-Yan, Lai Yi-Chen, Chang Ying-Jen, Cheng Wan-Jung, Hung Kuo-Chuan
Department of Anesthesiology, Chi Mei Medical Center, Liouying, Tainan, Taiwan.
School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan.
Obes Surg. 2025 May 7. doi: 10.1007/s11695-025-07900-x.
Obstructive sleep apnea (OSA) is highly prevalent in patients undergoing metabolic surgery and can complicate recovery. While OSA and COVID-19 share common pathophysiological mechanisms involving systemic inflammation and respiratory dysfunction, their combined impact on surgical outcomes remains poorly understood.
Using TriNetX data from June 2022 to December 2024, we retrospectively analyzed adult patients with OSA undergoing metabolic surgery. Patients were divided into two groups: those with COVID-19 infection within 4 weeks before surgery and controls without infection in the preceding 8 weeks. After propensity score matching, 8,733 pairs were analyzed. The primary outcomes included postoperative pneumonia and respiratory failure within 30 days. The secondary outcomes included acute kidney injury (AKI), intensive care unit (ICU) admission, mortality, surgical site infection (SSI), emergency department (ED) visit, and deep vein thrombosis (DVT).
No significant differences were found between the COVID-19 and control groups in postoperative pneumonia (0.28% vs. 0.32%, p = 0.5785) or respiratory failure (0.30% vs. 0.38%, p = 0.3613). Secondary outcomes, including the incidence of AKI, ICU admission, mortality, SSI, ED visit, and DVT, showed no significant differences. Chronic obstructive pulmonary disease (COPD) emerged as the strongest risk factor for both pneumonia (odds ratio 6.06, p = 0.002) and respiratory failure (odds ratio 4.22, p = 0.013).
Recent preoperative COVID-19 infection did not significantly impact postoperative outcomes in patients with OSA undergoing metabolic surgery. However, the presence of COPD substantially increases the risk of respiratory complications, suggesting the need for additional preoperative optimization in these patients.
阻塞性睡眠呼吸暂停（OSA）在接受代谢手术的患者中非常普遍，并且会使恢复过程复杂化。虽然OSA和2019冠状病毒病（COVID-19）具有涉及全身炎症和呼吸功能障碍的共同病理生理机制，但它们对手术结果的综合影响仍知之甚少。
利用2022年6月至2024年12月的TriNetX数据，我们回顾性分析了接受代谢手术的成年OSA患者。患者分为两组：术前4周内感染COVID-19的患者和术前8周内未感染的对照组。在倾向评分匹配后，分析了8733对患者。主要结局包括术后30天内的肺炎和呼吸衰竭。次要结局包括急性肾损伤（AKI）、重症监护病房（ICU）入院、死亡率、手术部位感染（SSI）、急诊就诊和深静脉血栓形成（DVT）。
COVID-19组和对照组在术后肺炎（0.28%对0.32%，p = 0.5785）或呼吸衰竭（0.30%对0.38%，p = 0.3613）方面没有显著差异。包括AKI、ICU入院、死亡率、SSI、急诊就诊和DVT发生率在内的次要结局也没有显著差异。慢性阻塞性肺疾病（COPD）是肺炎（优势比6.06，p = 0.002）和呼吸衰竭（优势比4.22，p = 0.013）的最强危险因素。
近期术前COVID-19感染对接受代谢手术的OSA患者的术后结局没有显著影响。然而，COPD的存在会大幅增加呼吸并发症的风险，这表明这些患者需要在术前进行额外的优化。
