Impact of obstructive sleep apnea on perioperative complications among patients undergoing hysterectomy: a population-based analysis

Introduction: Although obstructive sleep apnea (OSA)is a known risk factor for perioperative complications in various patient cohorts data is lacking for patients undergoing hysterectomies, one of the most frequently performed surgeries among women. Using national data we therefore aimed to assess the risk in this patient group. Materials and methods: We extracted data on patients who underwent a hysterectomy between 2006 and 2014 from a large nationwide database (n = 459,508). OSA patients (identified by ICD-9 CM codes)were compared to non-OSA patients regarding perioperative outcomes: cardiac, central-nervous, gastrointestinal, genitourinary, renal, respiratory, and thromboembolic complications; as well as opioid prescription, need for blood transfusion, cost of hospitalization, length of stay and ICU admission. Odds ratios (OR)and 95% confidence intervals (CI)are reported. Results: Overall, 2.67% (n = 11,936)of patients were identified as having OSA. Compared to non-OSA patients, OSA was particularly associated with higher odds for renal (OR 1.98; 95% CI 1.70–2.32)and respiratory complications (OR 3.25; 95% CI 2.97–3.56), and ICU admission (OR 2.28; 95% CI 1.77–2.94). Further, while significant, OSA was associated with modestly increased cost of hospitalization (+6.24%; P < 0.0001)and length of stay (+2.58%; P < 0.0001). Conclusions: In patients undergoing hysterectomies, OSA was associated with substantially increased risk of complications and modestly increased resource utilization. Further research is needed to assess currently used perioperative care strategies for OSA patients undergoing hysterectomies, with the goal to improve outcomes.