Obstructive sleep apnea is an independent risk factor for split-thickness skin graft failure

Obstructive sleep apnea (OSA) is an underdiagnosed and undertreated disease that has been significantly associated with diabetes, cardiovascular disease, peripheral arterial disease, and poor wound healing.

To determine whether or not OSA is an independent risk factor for split-thickness skin graft (STSG) failure in patients with chronic lower extremity (LE) wounds, given OSA's disease burden to common comorbidities in the LE wound population.

A retrospective chart review of chronic LE wounds managed with STSG between December 2014 and December 2022 was conducted. Patients with a diagnosis of OSA ("OSA") were compared with patients without an OSA diagnosis ("Non-OSA").

Overall, 14.9% of patients had OSA (n = 25) and 85.1% (n = 143) did not have OSA. Patients with OSA had a significantly higher median body mass index than the Non-OSA group (32.9 and 28.2, respectively; P = .013) and a higher rate of chronic obstructive pulmonary disease (16.0% and 4.2%, respectively; P = .043). Compared with patients without OSA, patients with OSA had more superficial wounds (P = .027) and received thinner skin grafts (P = .016). Compared with the Non-OSA group, wounds in the OSA group had significantly higher rates of graft failure (OSA 30.6% vs Non-OSA 15.9%; P = .034), infection (OSA 27.8% vs Non-OSA 10.6%; P = .005), and reoperation (OSA 52.8% vs Non-OSA 31.1%; P = .010). On multivariate logistic regression, OSA remained a significant risk factor for graft failure, increasing the odds of graft failure by 8.6 times (P = .040).

OSA is an independent predictor of graft failure in a highly comorbid population with chronic LE wounds. Preoperative identification of these high-risk patients should be undertaken by anesthesia, sleep medicine, and surgical teams to improve outcomes.