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Association of opioid prescription and perioperative complications in obstructive sleep apnea patients undergoing total joint arthroplasties

  • Sleep Breathing Physiology and Disorders • Original Article
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Abstract

Purpose

Obstructive sleep apnea (OSA) has been linked to higher rates of perioperative complications. Practice guidelines recommend minimizing opioids in this cohort to reduce complications. However, a paucity of evidence exists relating different levels of opioid prescription to perioperative complications. Our aim was to investigate if different levels of opioid prescription are related to perioperative complication risk in patients with OSA.

Methods

A total of 107,610 OSA patients undergoing total knee or hip arthroplasty between 2006 and 2013 were identified in a nationwide database and divided into subgroups according to the amount of opioids prescribed. We then compared those subgroups for odds of perioperative complications using multilevel multivariable logistic regression models.

Results

OSA patients with higher levels of opioid prescription had increased odds for gastrointestinal complications (OR 1.90, 95% CI 1.47–2.46), prolonged length of stay (OR 1.64, 95% CI 1.57–1.72), and increased cost of care (OR 1.48, 95% CI 1.40–1.57). However, we found lower odds for pulmonary complications (OR 0.85, 95% CI 0.74–0.96) for the high-prescription group.

Conclusions

Higher levels of opioid prescription were associated with higher odds for gastrointestinal complications and adverse effects on cost and length of stay but lower odds for pulmonary complications in OSA patients undergoing joint arthroplasties. The latter finding is unlikely causal but may represent more preventive measures and early interventions among those patients. Attempts to reduce opioid prescription should be undertaken to improve quality and safety of care in this challenging cohort in the perioperative setting.

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Author information

Authors and Affiliations

  1. Department of Anesthesiology, Hospital for Special Surgery, Weill Cornell Medical College, New York, NY, USA

    Eva E. Mörwald, Crispiana Cozowicz & Stavros G. Memtsoudis

  2. Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University, Salzburg, Austria

    Eva E. Mörwald, Crispiana Cozowicz & Stavros G. Memtsoudis

  3. Institute for Healthcare Delivery Science, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Ashley Olson, Jashvant Poeran & Madhu Mazumdar

  4. Department of Anesthesiology, Hospital for Special Surgery, 535 E 70th Street, New York, NY, 10021, USA

    Stavros G. Memtsoudis

Authors
  1. Eva E. Mörwald
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  2. Ashley Olson
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  3. Crispiana Cozowicz
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  4. Jashvant Poeran
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  5. Madhu Mazumdar
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  6. Stavros G. Memtsoudis
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Corresponding author

Correspondence to Stavros G. Memtsoudis.

Ethics declarations

No funding was received for this research.

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this manuscript.

For this type of study, formal consent is not required.

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Conflict of interest

Stavros G. Memtsoudis is funded by the Anna Maria and Stephen Kellen Career Development Award, New York.

Appendix

Appendix

Table 4 ICD-9 CM codes used to identify obstructive sleep apnea
Full size table
Table 5 ICD-9-CM diagnosis codes used to identify major perioperative complications
Full size table

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Mörwald, E.E., Olson, A., Cozowicz, C. et al. Association of opioid prescription and perioperative complications in obstructive sleep apnea patients undergoing total joint arthroplasties. Sleep Breath 22, 115–121 (2018). https://doi.org/10.1007/s11325-017-1539-9

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  • DOI: https://doi.org/10.1007/s11325-017-1539-9

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