TOPIC: Sleep Disorders
TYPE: Original Investigations
PURPOSE: Moderate to severe Obstructive Sleep Apnea (OSA) is estimated to affect 6-17% of the general adult population, though the majority of patients with OSA remain undiagnosed. OSA is a risk factor for multiple complications in surgical patients during the perioperative period. The Society of Anesthesia and Sleep Medicine (SASM) guidelines recommend preoperative screening for OSA in elective surgery patients. A questionnaire asking about Snoring, daytime Tiredness, Observed apneas, Hypertension, Body mass index (BMI)>35 kg/m2, Age >50years, Neck circumference >16” in females / >17” in males and Gender (STOP-BANG), has been validated as a screening tool for OSA. The diagnosis of OSA and the use of continuous positive airway pressure (CPAP) therapy may be associated with a reduction in postoperative complications. However, the role of enhanced monitoring and protocolized postoperative care is not clear. Our institution designed a protocol to screen patients for OSA in presurgical clinic visit (STOP-Bang questionnaire), followed by an order set including enhanced monitoring in those with known or suspected OSA. This study evaluated the rate of adherence to preoperative screening and to the post-operative protocol in patients with identified as a known or suspected OSA.
METHODS: A retrospective chart review was conducted to identify the rate of adherence to MetroHealth’s perioperative OSA protocol in patients with known or suspected OSA. Inclusion criteria included age ≥ 18 years and patients with overnight hospital stay after elective surgery. Charts of patients visiting the pre-surgical evaluation clinic during September 2019 were reviewed to determine rates of pre-operative screening and post-operative adherence to the protocol (dedicated “OSA beds” on the surgical floors, specific order set for opioids).
RESULTS: A retrospective review of 534 patient charts was conducted. Utilizing the STOP-Bang questionnaire, 94.5% (505/534) of patients were screened at the presurgical clinic. Out of those screened, 20.2% had known OSA, and 21.2% were found to be at risk of OSA (STOP-Bang score 3 or more). 24.3% of patients with known OSA and 23.8% with suspected OSA were admitted following surgery The majority of patients, 80.9% of patients in the OSA group and 90% of patients in the at-risk group, were assigned to the correct OSA protocol beds. However, only 7.7% of patients with OSA received CPAP postoperatively. 84.6% of OSA patients received oral opioids and 76.9% received IV opioids. 78.2% of patients at risk of OSA received oral opioids and 73.9% received IV opioids.
CONCLUSIONS: The overwhelming majority of patients were screened for OSA at pre-surgical evaluation, and most were placed in the correct post-operative monitored setting. The use of CPAP therapy postoperatively was poor.
CLINICAL IMPLICATIONS: This study demonstrates the challenges of implementing a perioperative protocol following screening patients during pre-surgical evaluation. The implications of cases where the protocol is not followed, and the lack of CPAP use postoperatively, are being further investigated.
DISCLOSURES: No relevant relationships by Dennis Auckley, source=Web Response
No relevant relationships by Sunjeet Kaur, source=Web Response
No relevant relationships by Nhi Lam, source=Web Response
No relevant relationships by Nicoleta Olteanu, source=Web Response
© 2021 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.