Sleep-Disordered Breathing and Postoperative Outcomes After Elective Surgery Analysis of the Nationwide Inpatient Sample
Sleep-Disordered Breathing and Postoperative Outcomes After Elective Surgery Analysis of the Nationwide Inpatient Sample
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DOI：
10.1378/chest.12-2905
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发表时间：
2013-09-01
期刊：
影响因子：
9.6
通讯作者：
Meltzer, David O.
中科院分区：
文献类型：
--
作者：
Mokhlesi, Babak;Hovda, Margaret D.;Meltzer, David O.
工作背景：对术前患者进行睡眠呼吸障碍（SDB）或阻塞性睡眠呼吸暂停（OSA）的系统筛查和治疗将带来显著的成本负担;因此，了解SDB是否与术后结局恶化相关非常重要。我们试图确定SDB对接受四种特定类别择期手术（骨科、前列腺、腹部和心血管）患者术后结局的影响。主要结局为院内死亡、总费用和住院时间（LOS）。两个次要结果的利益是呼吸和心脏consequence.Methods：数据来自全国住院病人样本数据库。回归模型进行拟合，以评估SDB和interests. Results的结果之间的独立关联：队列包括1,058,710住院成人患者接受择期手术2004年至2008年之间。SDB与骨科手术死亡率降低独立相关，（OR，0.65; 95% CI，0.45-0.95; P = .03），腹部（OR，0.38; 95% CI，0.22-0.65; P = .001）和心血管手术组（OR，0.54; 95% CI，0.40-0.73; P < .001），但对前列腺手术组的死亡率没有影响。SDB与骨科手术组的估计平均LOS增加0.14天（P <0.001）和估计平均总费用增加860美元（P <0.001）独立相关，但与前列腺手术组的LOS或总费用增加无关。在腹部和心血管手术组中，SDB与调整后的平均LOS显著减少相关，分别为1.1天和0.35天（两组P <0.001），调整后的平均总费用分别为3，814美元和4，592美元（两组P <0.001）。在所有四种手术类别中，SDB与紧急插管和机械通气、无创通气和房颤的OR显著增加独立相关。SDB患者的紧急插管发生在术后过程中明显提前。在亚组的患者需要紧急插管，LOS，总费用，肺炎，并在医院死亡显着高于那些没有SDB。结论：在这个大型的国家研究，尽管SDB与术后心肺并发症的独立关联增加，SDB的诊断是不是独立相关的院内死亡率增加。SDB对手术类别的LOS和总费用有不同的影响。
Background: Systematic screening and treatment of sleep-disordered breathing (SDB) or obstructive sleep apnea (OSA) in presurgical patients would impose a significant cost burden; therefore, it is important to understand whether SDB is associated with worse postoperative outcomes. We sought to determine the impact of SDB on postoperative outcomes in patients undergoing four specific categories of elective surgery (orthopedic, prostate, abdominal, and cardiovascular). The primary outcomes were in-hospital death, total charges, and length of stay (LOS). Two secondary outcomes of interest were respiratory and cardiac complications.Methods: Data were obtained from the Nationwide Inpatient Sample database. Regression models were fitted to assess the independent association between SDB and the outcomes of interest.Results: The cohort included 1,058,710 hospitalized adult patients undergoing elective surgeries between 2004 and 2008. SDB was independently associated with decreased mortality in the orthopedic (OR, 0.65; 95% CI, 0.45-0.95; P = .03), abdominal (OR, 0.38; 95% CI, 0.22-0.65; P = .001), and cardiovascular surgery groups (OR, 0.54; 95% CI, 0.40-0.73; P < .001) but had no impact on mortality in the prostate surgery group. SDB was independently associated with a small, but statistically significant increase in estimated mean LOS by 0.14 days (P < .001) and estimated mean total charges by $860 (P < .001) in the orthopedic surgery group but was not associated with increased LOS or total charges in the prostate surgery group. In the abdominal and cardiovascular surgery groups, SDB was associated with a significant decrease in adjusted mean LOS of 1.1 days and 0.35 days, respectively (P < .001 for both groups), and adjusted mean total charges of $3,814 and $4,592, respectively (P < .001 for both groups). SDB was independently associated with a significantly increased OR for emergent intubation and mechanical ventilation, noninvasive ventilation, and atrial fibrillation in all four surgical categories. Emergent intubation occurred significantly earlier in the postoperative course in patients with SDB. In the subgroup of patients requiring emergent intubation, LOS, total charges, pneumonias, and in-hospital death were significantly higher in those without SDB.Conclusions: In this large national study, despite the increased independent association of SDB with postoperative cardiopulmonary complications, the diagnosis of SDB was not independently associated with an increased rate of in-hospital death. SDB had a mixed impact on LOS and total charges by surgical category.