0467 THE ROLE OF OBSTRUCTIVE SLEEP APNEA AND OBESITY IN POSTOPERATIVE OUTCOMES: A POPULATION-BASED STUDY IN PATIENTS UNDERGOING OPEN COLECTOMIES

Abstract

Introduction: An increasing body of evidence demonstrates an association between obstructive sleep apnea (OSA) and adverse perioperative outcomes with national data existing on particularly orthopedic and bariatric surgery. However, large scale data is currently lacking on open colectomies: procedures associated with high opioid utilization and high complication rates. Moreover, the interaction between obesity and OSA in this setting remains undefined. Methods: Patients undergoing open colectomies were identified using the national Premier Perspective claims-based database (2006-2014; n=275,064). Multilevel multivariable models measured the associations between an OSA∗obesity interaction term and perioperative outcomes: length and cost of hospitalization, opioid utilization (in oral morphine equivalents), respiratory and cardiac complications, ICU admission, mechanical ventilation, and in-hospital mortality. Odds ratios (OR) and 95% confidence intervals (CI) are reported. Results: Overall, 4.9% (n=13,383) of patients had a diagnosis code for OSA of which 46.5% (n=6,460) was classified as obese. When adjusted for relevant covariates, OSA (with and without obesity, respectively) was associated with 17.6% (CI 15.2-20.0%) and 5.4% (CI 3.4-7.4%) increased cost of hospitalization; this was 9.4% (CI 8.3-10.6%) for obesity without OSA (all P<0.0001). Interestingly, other perioperative outcomes followed this same pattern: highest risks for OSA/obesity combined, with obesity more important in this risk than OSA. The strongest effects were seen for respiratory complications: OR 2.51 (CI 2.35-2.68), OR 1.43 (CI 1.33-1.54), OR 1.52 (CI 1.45-1.58), for OSA with obesity, OSA without obesity, and obesity without OSA, respectively (all P<0.0001). Conclusion: OSA is associated with adverse perioperative outcomes in patients undergoing open colectomies. However, obesity without OSA appears to exert a stronger risk than OSA without obesity, with a synergistic effect if both OSA and obesity are present. Given the high volume of open colectomies, and the large proportion of undetected OSA further research is warranted into not only risk stratification but also effectiveness of tailored interventions.