Sleep-Disordered Breathing and Postoperative Outcomes After Bariatric Surgery: Analysis of the Nationwide Inpatient Sample
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.
KeywordsSleep-disordered breathing Bariatric surgery Obstructive sleep apnea Postoperative complications Intubation Respiratory failure Death Length of stay Cost
Charlson comorbidity index
Continuous positive airway pressure/noninvasive ventilation
International Classification of Diseases, 9th Revision, Clinical Modification
Length of stay
Nationwide inpatient sample
This study was supported by the University of Chicago Institute for Translational Medicine and the Clinical and Translational Science Awards (CTSA) program (UL1 RR024999). Dr. Arora is supported by the National Institutes on Aging (K23 AG033763). Dr. Meltzer is supported by a Midcareer Career Development Award from the National Institutes of Health (1 K24 AG031326-01).
Conflict of Interest Statement
Babak Mokhlesi has served as a consultant for Philips/Respironics, but has no conflicts of interest relevant to the present study. Margaret D. Hovda, Benjamin Vekhter, Vineet M. Arora, Frances Chung, and David O. Meltzer have no conflicts of interest relevant to the present study to declare.
Role of the Sponsor
The sponsor had no role in the design and conduct of the study, in the collection, analysis, and interpretation of the data, or in the preparation, review, or approval of the manuscript.
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