Summary: Patients with OSA who used CPAP therapy before total hip and knee replacement surgeries had significantly fewer complications post-surgery compared to those who didn’t use CPAP, finds a study conducted by the Hospital for Special Surgery.
In a study presented by the Hospital for Special Surgery at the 14th annual meeting of the Society of Anesthesia and Sleep Medicine, CPAP reduced the risk of complications post-surgery to the point where OSA patients who used CPAP had similar emergency department visit rates as those without obstructive sleep apnea (OSA).
“Obstructive sleep apnea affects 40 million adults in the United States and is associated with an increased complication risk among patients undergoing surgery,” says Stavros Memtsoudis, MD, PhD, anesthesiologist-in-chief and chair of the Hospital for Special Surgery Department of Anesthesiology, Critical Care, & Pain Management, in a release. “Guidelines on the perioperative management of OSA patients undergoing surgery are backed by limited evidence. Current recommendations include preoperative screening for OSA and preoperative initiation of CPAP therapy. However, it remains unclear how often this recommendation is followed and how much it reduces complication risks.”
This information is especially important as healthcare systems shift from inpatient to outpatient hip and knee replacement surgery, where patients cannot be monitored as closely for perioperative complications.
Study Methodology
- Data Source: Merative MarketScan national claims data (2018-2022), covering over 100,000 outpatient hip and knee replacement surgeries.
- Outcome Measure: Emergy room visits within one day of discharge, used to represent post-discharge complications.
- Comparisons Made:
- OSA patients who used CPAP before surgery vs. OSA patients who did not.
- OSA patients without CPAP vs. patients without OSA.
- OSA patients with preoperative CPAP vs. patients without OSA.
Study Findings
- 19% of the 123,349 surgeries studied involved OSA patients using CPAP preoperatively.
- These patients had fewer emergency room visits post-discharge compared to OSA patients who didn’t use CPAP.
- CPAP lowered complication risks in OSA patients to levels similar to those without OSA.
Significance of CPAP Use Findings
“These findings are significant as they support the notion that adhering to these guidelines can benefit OSA patients undergoing surgery,” says Jashvant Poeran, MD, PhD, director of research in the HSS Department of Anesthesiology, Critical Care, & Pain Management, in a release. “While we had anticipated these results based on the guidelines, this is the first study to demonstrate this on such a large scale.”
This study offers key insights for both patients and clinicians on ways to reduce the risk of complications after surgery.
“It informs patients with OSA to engage in conversations with their perioperative physicians about strategies to lower their complication risk, including the preoperative initiation of CPAP therapy,” Poeran says. “Additionally, this research highlights the advantages of preoperative initiation of CPAP therapy. We believe that this study strengthens the evidence supporting the benefits of preoperative CPAP therapy and will encourage both patients and clinicians to consider its increased use.”
While further validation of these findings is necessary, particularly in other surgical cohorts such as elective general surgery, these findings represent a significant advancement in recognizing the benefits of preoperative initiation of CPAP therapy.
“These findings could influence care by emphasizing the importance of preoperative identification of OSA patients who are scheduled for surgery and subsequent initiation of CPAP therapy,” Poeran says.
[Related: Tertiary Care Facility Shares Its Approach to Obstructive Sleep Apnea in Perioperative Population]
Potential Future Research
In addition to replicating these findings in other surgical cohorts, future research should also examine subgroups of patients in which preoperative CPAP therapy may be even more beneficial. “These subgroups might include patients with multiple risk factors, such as OSA and obesity or other chronic conditions, as well as those with varying needs for opioid management,” Poeran says. “Follow-up studies could investigate looking at other recommendations outlined in the guidelines such as preoperative screening for OSA and enhanced monitoring. This increased monitoring is crucial as hospital stays shorten and more and more surgeries are performed in an outpatient setting without an overnight stay and the subsequent opportunity to monitor these patients.”
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