Studies on perioperative outcomes in patients with sleep apnea and pulmonary hypertension are rare and existing analyses are limited primarily by insufficient sample size. Utilizing nationally representative data collected for the Nationwide Inpatient Sample, the largest all-payer database in the U.S., we were able to perform two studies determining the impact of 1) obstructive sleep apnea (OSA) and 2) pulmonary hypertension on in-hospital complications.
We determined that both orthopedic and general surgical patients suffering from OSAhad increased risk of pulmonary adverse events, including adult respiratory distress syndrome (ORs 2.39 and 1.58), aspiration pneumonia (ORs1.41 and 1.37), and the need for mechanical ventilation (ORs 5.20 and 1.95) vs. non-OSA patients. OSApatients undergoing hip or knee arthroplasty were also more likely to suffer from perioperative pulmonary embolism compared to non-OSA patients (OR 1.22).
When matching patients with pulmonary hypertension with those without the disease, the former exhibited significantly higher perioperative rates of complications and mortality. These findings confirm the long held believe amongst clinicians, that patients with OSA and pulmonary hypertension indeed represent at risk populations in the surgical setting.
They further support the hypothesis, that increased rates of pulmonary hypertension and right heart dysfunction among OSA patients may explain worse outcomes, especially in the orthopedic patients. Here, embolization of bone marrow and cement during instrumention of the joint may lead to increased risk of lung injury, and worsening of right heart dysfunction resulting in chamber dilatation, venostasis and subsequently increased risk for thromboembolism.