The early postoperative course of surgical sleep apnea patients

Recent guidelines from the American Society of Anesthesiologists recommended postoperative monitoring for most patients undergoing surgery for obstructive sleep apnea (OSA). These guidelines, however, are largely based on retrospective literature and expert opinion. The appropriate level of postoperative monitoring remains controversial. Our objective was to prospectively document the early postoperative course of patients undergoing OSA surgery.

Prospective cohort study.

One hundred twenty-one patients (age 43.9 + or - 13.5 years, 79.8% male) with sleep-study proven OSA (apnea-hypopnea index 31.9 + or - 22.7) who were undergoing surgery for OSA at our tertiary care center were recruited from 2007 to 2009. Outcome measures were: 1) incidence of respiratory complications requiring nursing intervention, 2) level of postoperative blood oxygen saturation divided into three groups: mean oxygen saturation in recovery room (SpO2(recovery)), mean oxygen saturation in step-up unit (SpO2(step-up)), and lowest oxygen saturation over the 24 hour period (SpO2(minimum)). These results were then compared to the benchmark literature.

The overall incidence of nursing intervention in response to a respiratory complication (3.4%) was significantly less than expected (P < .002). Mean SpO2(recovery) was 92.9 + or - 3.2%, SpO2(step-up) was 95.9 + or - 1.6%, and SpO2(minimum) was 92.8 + or - 3.1%. No variables were identified as being predictive of any of the outcome measures.

The incidence of respiratory events requiring intervention in the early postoperative course of OSA patients was low (3.4%). Routine postoperative inpatient monitoring may not be required in many cases.