Sleep apnea increases odds of 90-day postoperative complications and healthcare utilization following lumbar discectomy.

INTRODUCTION

Postoperative adverse events following lumbar discectomy (LD) are important to characterize for patient counseling and risk management, particularly in potentially vulnerable patient populations, such as those with sleep apnea (SA). Although increasing screening and optimization pathways are starting to be put into place for patients with SA in general, specific attention to this condition in relation to LD has not been reported.

METHODS

Adult patients undergoing isolated, single-level, lumbar laminotomy/discectomy were identified from the 2010 to 2022 PearlDiver Mariner database. Those without versus with SA were matched 4:1 based on age, sex, and Elixhauser comorbidity index (ECI). Ninety-day severe and minor adverse events, emergency department (ED) visits, and readmissions were assessed and compared with multivariate analysis. Overall 90-day reimbursements and 5-year revisions were assessed and compared.

RESULTS

Of a total of 200,515 LD patient, SA was identified for 24,975 (12.5%). After matching, there were 74,391 without sleep apnea and 18,734 with sleep apnea. Patients with SA had independently higher odds-ratio (OR) of experiencing most 90-day postoperative adverse events, as well as aggregated severe (OR: 1.60) and minor (OR: 2.66) adverse events (p<.0001 for each). Patients with SA were also at higher odds of 90-day ED visits (OR: 2.76) and median overall 90-day reimbursement ($3,300.00 vs.. $3,106.00) (p<.0001 for both). Further, patients with SA were more likely to undergo 5-year subsequent lumbar surgery (p=.01).

CONCLUSIONS

While increasing attention has been given to SA around surgical interventions, the current study defined that over a tenth of LD patients had diagnosed SA and were at greater odds of severe and minor adverse events, as well as reoperations, in their postoperative period. This translated to greater health care utilization and cost. Consequently, patients with SA ought to receive supplemental risk counseling and postoperative resource planning when considered for LD.