Respiratory Depression Following Ambulatory Urogynecologic Procedures: A Retrospective Analysis

Mayo Clin Proc Innov Qual Outcomes. 2019 May 27;3(2):169-175. doi: 10.1016/j.mayocpiqo.2019.02.002. eCollection 2019 Jun.


Objective: To assess the rate of postanesthesia respiratory depression (RD) and test for potential associations with clinical characteristics of patients undergoing urogynecologic procedures at ambulatory surgical centers (ASCs). Postanesthesia RD is poorly characterized for patients undergoing urogynecologic procedures in ASCs.

Patients and methods: Health records of adult patients undergoing urogynecologic procedures at an ASC from July 1, 2010, through December 31, 2015, were abstracted. Cases complicated by RD were identified, and analyses of risk factors were performed with generalized estimating equations (GEE).

Results: During the study time frame, 9105 patients underwent 9141 procedures, of which RD complicated 221 cases (mean [95% confidence interval (CI)] complication rate per 100 cases, 2.4 [2.1-2.8]). Risk increased with advancing age, male sex, obstructive sleep apnea (OSA), morbid obesity, and use of volatile anesthetics and airway secured. Patients with RD had longer anesthesia recovery (median [interquartile range], 135 [110-166] vs 105 [80-138] minutes; P<.001). Within 48 postprocedural hours, 290 ED visits or hospitalizations occurred, but this risk was not increased by RD (adjusted odds ratio [95% CI], 0.62 [0.30-1.26]; P=.12).

Conclusion: Postanesthesia RD after ambulatory urogynecologic procedures delay anesthesia recovery but are not associated with later complications. Patients with OSA or having other conditions related to OSA, or both, are at higher risk for RD.

Keywords: ASC, ambulatory surgical center; BMI, body mass index; CPAP, continuous positive airway pressure; IQR, interquartile range; OR, odds ratio; OSA, obstructive sleep apnea; PACU, postanesthesia care unit; RD, respiratory depression; SpO2, oxygen saturation as measured by pulse oximetry.