Obesity Surgery

, Volume 23, Issue 11, pp 1842–1851

Sleep-Disordered Breathing and Postoperative Outcomes After Bariatric Surgery: Analysis of the Nationwide Inpatient Sample

  • Babak Mokhlesi
  • Margaret D. Hovda
  • Benjamin Vekhter
  • Vineet M. Arora
  • Frances Chung
  • David O. Meltzer
Original Contributions



Sleep-disordered breathing (SDB), also known as obstructive sleep apnea (OSA), has been increasingly recognized as a possible risk factor for adverse perioperative outcomes in non-bariatric surgeries. However, the impact of SDB on postoperative outcomes in patients undergoing bariatric surgery remains less clearly defined. We hypothesized that SDB would be independently associated with worse postoperative outcomes.


Data were obtained from the Nationwide Inpatient Sample database and included a total of 91,028 adult patients undergoing bariatric surgeries from 2004 to 2008. The primary outcomes were in-hospital death, total charges, and length of stay. There were two secondary outcomes of interest: respiratory and cardiac complications. Regression models were fitted to assess the independent association between SDB and the outcomes of interest.


SDB was independently associated with decreased mortality (OR = 0.34, 95% CI = 0.23–0.50, p < 0.001), total charges (−$869, p < 0.001), and length of stay (−0.25 days, p < 0.001). SDB was independently associated with significantly increased odds ratio of emergent endotracheal intubation (OR = 4.35, 95% CI = 3.97–4.77, p < 0.001), noninvasive ventilation (OR = 14.12, 95% CI = 12.09–16.51, p < 0.001), and atrial fibrillation (OR = 1.25, 95% CI = 1.11–1.41, p < 0.001). Emergent intubation occurred significantly earlier in the postoperative course in patients with SDB. Although non-SDB patients had an overall lower risk of emergent intubation compared to SDB patients, their outcomes were significantly worse when they did get emergently intubated.


In this large nationally representative sample, despite the increased association of SDB/OSA with postoperative cardiopulmonary complications, the diagnosis of SDB/OSA was negatively, rather than positively, associated with in-hospital mortality and resource use.


Sleep-disordered breathing Bariatric surgery Obstructive sleep apnea Postoperative complications Intubation Respiratory failure Death Length of stay Cost 



Charlson comorbidity index


Confidence interval


Continuous positive airway pressure/noninvasive ventilation


International Classification of Diseases, 9th Revision, Clinical Modification


Length of stay


Nationwide inpatient sample


Odds ratio


Sleep-disordered breathing

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Babak Mokhlesi
    • 1
  • Margaret D. Hovda
    • 1
  • Benjamin Vekhter
    • 2
  • Vineet M. Arora
    • 2
    • 3
  • Frances Chung
    • 4
  • David O. Meltzer
    • 2
    • 5
  1. 1.Sleep Disorders Center and the Section of Pulmonary and Critical Care, Department of MedicineThe University of ChicagoChicagoUSA
  2. 2.Center for Health and Social SciencesThe University of ChicagoChicagoUSA
  3. 3.Section of General Internal Medicine, Department of MedicineThe University of ChicagoChicagoUSA
  4. 4.Department of AnesthesiaUniversity Health Network, University of TorontoTorontoCanada
  5. 5.Section of Hospital Medicine, Department of MedicineThe University of ChicagoChicagoUSA

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