Sleep-disordered breathing and postoperative outcomes after bariatric surgery: analysis of the nationwide inpatient sample

Abstract

Background: Sleep-disordered breathing (SDB), also known as obstructive sleep apnea (OSA), has been increasingly recognized as a possible risk factor for adverse perioperative outcomes in non-bariatric surgeries. However, the impact of SDB on postoperative outcomes in patients undergoing bariatric surgery remains less clearly defined. We hypothesized that SDB would be independently associated with worse postoperative outcomes.

Methods: Data were obtained from the Nationwide Inpatient Sample database and included a total of 91,028 adult patients undergoing bariatric surgeries from 2004 to 2008. The primary outcomes were in-hospital death, total charges, and length of stay. There were two secondary outcomes of interest: respiratory and cardiac complications. Regression models were fitted to assess the independent association between SDB and the outcomes of interest.

Results: SDB was independently associated with decreased mortality (OR = 0.34, 95% CI = 0.23-0.50, p < 0.001), total charges (-$869, p < 0.001), and length of stay (-0.25 days, p < 0.001). SDB was independently associated with significantly increased odds ratio of emergent endotracheal intubation (OR = 4.35, 95% CI = 3.97-4.77, p < 0.001), noninvasive ventilation (OR = 14.12, 95% CI = 12.09-16.51, p < 0.001), and atrial fibrillation (OR = 1.25, 95% CI = 1.11-1.41, p < 0.001). Emergent intubation occurred significantly earlier in the postoperative course in patients with SDB. Although non-SDB patients had an overall lower risk of emergent intubation compared to SDB patients, their outcomes were significantly worse when they did get emergently intubated.

Conclusions: In this large nationally representative sample, despite the increased association of SDB/OSA with postoperative cardiopulmonary complications, the diagnosis of SDB/OSA was negatively, rather than positively, associated with in-hospital mortality and resource use.

Figure 1

Unadjusted outcomes for atrial fibrillation, respiratory failure, CPAP/NIV use, and emergent intubation in patients with and without SDB. * p <0.01

Figure 2

Mean adjusted total charges in all patients undergoing bariatric surgery (n=91,028) and the subset of bariatric patients that required emergent intubation (n=2,572) based on SDB status. * p <0.001

Figure 3

Mean adjusted length of stay in all patients undergoing bariatric surgery (n=91,028) and the subset of bariatric surgery patients that required emergent intubation (n=2,572) based on SDB status. * p <0.001