Unplanned admission after day surgery: A historical cohort study in patients with obstructive sleep apnea
Canadian Journal of Anesthesia,
Bryson GL et al. – The authors did not identify a clinically important increased rate of unplanned admission associated with a prior diagnosis of obstructive sleep apnea (OSA).Methods
- A historical cohort study (July 2003 to March 2009) was conducted using administrative data and supplemented by selective chart review.
- Patients undergoing ambulatory surgery at the Ottawa Hospital who had a previously documented PSG were identified.
- The PSG reports were reviewed, and the presence and severity of OSA was determined.
- Unplanned admissions to hospital within seven days of surgery were identified using administrative data.
- Using a nested case–control design, three charts were randomly selected for each patient admitted for a focussed health records review.
- Event rates in patients with OSA and treated with continuous airway pressure were compared with event rates in patients without OSA.
- An exploratory multivariable analysis was conducted to identify predictors of admission.
- There were 77,809 ambulatory surgical procedures in the period studied.
- A PSG test could be analyzed in 1,547 patients, and OSA was diagnosed in 674 (44%) of those analyzed.
- The rate of unplanned admission was 7.0% (95% confidence interval [CI] 5.1 to 8.9) in OSA patients compared with 5.6% (95% CI 4.1 to 7.1) in patients without OSA (odds ratio 1.26; 95% CI 0.83 to 1.91; P=0.246).
- Median [interquartile range; IQR] hospital length of stay was 7 hr [IQR 5, 8] with OSA and 6 hr [IQR 5, 8] without OSA (P=0.058).
- Severity of OSA was not associated with unplanned admission.