Quality and Outcomes (RK Shah, Section editor)

Current Otorhinolaryngology Reports

, Volume 2, Issue 1, pp 20-29

Obstructive Sleep Apnea and Surgery: Quality Improvement Imperatives and Opportunities

  • Michael J. BrennerAffiliated withDepartment of Otolaryngology–Head & Neck Surgery, 1904 Taubman Center, University of Michigan School of Medicine Email author 
  • , Julie L. GoldmanAffiliated withDivision of Otolaryngology, James Graham Brown Cancer Center, University of Louisville School of Medicine

Abstract

Obstructive sleep apnea (OSA) is more common in surgical candidates than in the general population and may increase susceptibility to perioperative complications that range from transient desaturation to catastrophic injuries. Understanding the potential impact of OSA on patients’ surgical risk profile is of particular interest to otolaryngologists, who routinely perform airway procedures—including surgical procedures for treatment of OSA. Whereas the effects of OSA on long-term health outcomes are well documented, the relationship between OSA and surgical risk is not collinear, and clear consensus on the nature of the association is lacking. Better guidelines for optimization of pain control, perioperative monitoring, and surgical decision making are potential areas for quality improvement efforts. Many interventions have been suggested to mitigate the risk of adverse events in surgical patients with OSA, but wide variations in clinical practice remain. We review the current literature, emphasizing recent progress in understanding the complex pathophysiologic interactions noted in OSA patients undergoing surgery and outlining potential strategies to decrease perioperative risks.

Keywords

Obstructive sleep apnea (OSA) Otolaryngologic surgery Quality improvement Patient safety Anesthesia Narcotics