Postop complications with sleep apnea seen even after regional anesthesia

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By Will Boggs MD

NEW YORK (Reuters Health) - Patients with obstructive sleep apnea (OSA) have an increased risk of postoperative complications and prolonged hospital stay, even in a setting with near-universal regional-anesthesia use, according to new findings.

"While interventions that may reduce secondary risk in OSA patients, such as using regional anesthesia to decrease opioid consumption, may play an important role, physicians should not let their guard down," said Dr. Stavros G. Memtsoudis of the Hospital for Special Surgery and Weill Cornell Medical College, New York.

"It will take many more improvements in all aspects of perioperative care, including better preoperative diagnosis and treatment and possibly better targeted and more effective monitoring, to minimize risk in OSA patients," he told Reuters Health by email.

OSA is a recognized risk factor for adverse postoperative outcomes, and perioperative professional societies recommend the use of regional anesthesia to reduce postoperative complications in patients with OSA.

Dr. Memtsoudis's team investigated the impact of OSA on postoperative complications in their high-volume orthopedic surgery practice, which has a strong focus on regional anesthesia.

The study included more than 21,000 total hip arthroplasties (THA, 6.3% with OSA) and more than 20,000 total knee arthroplasties (TKA, 9.1% with OSA); 97.8% of surgeries were performed under neuraxial (regional) anesthesia.

In multivariable analysis, OSA was associated with 87% higher odds of pulmonary complications, 52% higher odds of gastrointestinal complications, and 44% higher odds of prolonged length of hospital stay, the researchers report in Regional Anesthesia and Pain Medicine, online January 11. These risk increases were all statistically significant.

OSA did not significantly increase the odds of renal/genitourinary complications, delirium, cardiac complications, or thromboembolic complications.

The few patients who had general anesthesia (3.1% of patients with OSA and 2.1% of patients without OSA) had significantly higher rates of pulmonary and renal/genitourinary complications, delirium and prolonged length of stay, compared with the majority of patients who had regional anesthesia.

"The main focus of perioperative OSA care that needs to be addressed in the future is preoperative optimization," Dr. Memtsoudis said. "We have spent decades applying this principle to comorbidities like pulmonary and cardiac diseases, as well as diabetes, yet when it comes to OSA, the vast majority of patients presenting for surgery with OSA remain undiagnosed and untreated."

"Future studies should try and investigate if among neuraxial techniques one has a better potential to reduce the risk of complications in patients with OSA than other neuraxial techniques," the researchers conclude. "Furthermore, as we know that patients with OSA undergoing lower joint arthroplasty are at risk even in a regional anesthesia setting, other interventions that could potentially lead to a better outcome in this patient group should be investigated."

SOURCE: https://bit.ly/2GkaV5g

Reg Anesth Pain Med 2019.

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