Chest
Volume 149, Issue 1, January 2016, Pages 84-91
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Original Research: Sleep Disorders
Postoperative Complications in Patients With Unrecognized Obesity Hypoventilation Syndrome Undergoing Elective Noncardiac Surgery

https://doi.org/10.1378/chest.14-3216Get rights and content

Background

Among patients with OSA, a higher number of medical morbidities are known to be associated with those who have obesity hypoventilation syndrome (OHS) compared with OSA alone. OHS can pose a higher risk of postoperative complications after elective noncardiac surgery (NCS) and often is unrecognized at the time of surgery. The objective of this study was to retrospectively identify patients with OHS and compare their postoperative outcomes with those of patients with OSA alone.

Methods

Patients meeting criteria for OHS were identified within a large cohort with OSA who underwent elective NCS at a major tertiary care center. We identified postoperative outcomes associated with OSA and OHS as well as the clinical determinants of OHS (BMI, apnea-hypopnea index [AHI]). Multivariable logistic and linear regression models were used for dichotomous and continuous outcomes, respectively.

Results

Patients with hypercapnia from definite or possible OHS and overlap syndrome are more likely to experience postoperative respiratory failure (OR, 10.9; 95% CI, 3.7-32.3; P < .0001), postoperative heart failure (OR, 5.4; 95% CI, 1.9-15.7; P = .002), prolonged intubation (OR, 3.1; 95% CI, 0.6-15.3; P = .2), postoperative ICU transfer (OR, 10.9; 95% CI, 3.7-32.3; P < .0001), and longer ICU (β-coefficient, 0.86; SE, 0.32; P = .009) and hospital (β-coefficient, 2.94; SE, 0.87; P = .0008) lengths of stay compared with patients with OSA. Among the clinical determinants of OHS, neither BMI nor AHI showed associations with any postoperative outcomes in univariable or multivariable regression.

Conclusions

Better emphasis is needed on preoperative recognition of hypercapnia among patients with OSA or overlap syndrome undergoing elective NCS.

Section snippets

Materials and Methods

The study protocol was approved by the Cleveland Clinic Institutional Review Board, #12-625.

Results

A total of 1,800 patients with BMI ≥ 30 kg/m2 who underwent PSG, NCS, and ABG analysis on more than one occasion were identified. One hundred ninety-four met criteria for possible or definite OHS per study protocol. Of these, 139 (72%) had OSA at the time of elective surgery, and the remaining patients (28%) received an OSA diagnosis after PSG within 1 to 5 years postsurgery. Another cohort of 325 had OSA around the time of NCS but either did not meet the ABG criteria for OHS or did not have an

Discussion

Among patients with OSA by PSG, significantly worse postoperative outcomes were noted if patients were previously known to be hypercapnic from OHS with or without overlap syndrome. In our experience, this study is the first to report perioperative outcomes in patients with known or suspected OHS. The only other time postoperative outcomes have been reported among patients with a high likelihood of OHS was with the use of the Obesity Surgery Mortality Risk Score in those undergoing bariatric

Conclusions

Among patients with OSA, a higher number of medical morbidities are known to be associated with those who have OHS compared with OSA alone. Consequently, a higher number of postoperative complications are expected in this group, regardless of BMI or AHI. The risk and frequency of postoperative complications are also higher in patients with OSA and COPD (overlap syndrome) and appear to be no different than that associated with OHS.

Acknowledgments

Author contributions: R. K. had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. R. K. contributed to the study conception, data collection, data analysis and interpretation, and writing and final approval of the manuscript; P. B., H. P., A. R., and A. D. contributed to the data collection and approval of the final manuscript; A. V. H. contributed to the statistical analysis and writing and final approval

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FUNDING/SUPPORT: The authors have reported to CHEST that no funding was received for this study.

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