Sleep-Disordered Breathing and Postoperative Outcomes After Bariatric Surgery: Analysis of the Nationwide Inpatient Sample
Open accessAbstract
Background Sleep-disordered breathing (SDB), also known as obstructive sleep apnea (OSA), has been increasingly recognized as a possible risk factor for adverse perioperative outcomes in non-bariatric surgeries. However, the impact of SDB on postoperative outcomes in patients undergoing bariatric surgery remains less clearly defined. We hypothesized that SDB would be independently associated with worse postoperative outcomes.Methods Data were obtained from the Nationwide Inpatient Sample database and included a total of 91,028 adult patients undergoing bariatric surgeries from 2004 to 2008. The primary outcomes were in-hospital death, total charges, and length of stay. There were two secondary outcomes of interest: respiratory and cardiac complications. Regression models were fitted to assess the independent association between SDB and the outcomes of interest.Results SDB was independently associated with decreased mortality (OR = 0.34, 95% CI = 0.23-0.50, p < 0.001), total charges (-$869, p < 0.001), and length of stay (-0.25 days, p < 0.001). SDB was independently associated with significantly increased odds ratio of emergent endotracheal intubation (OR = 4.35, 95% CI = 3.97-4.77, p < 0.001), noninvasive ventilation (OR = 14.12, 95% CI = 12.09-16.51, p < 0.001), and atrial fibrillation (OR = 1.25, 95% CI = 1.11-1.41, p < 0.001). Emergent intubation occurred significantly earlier in the postoperative course in patients with SDB. Although non-SDB patients had an overall lower risk of emergent intubation compared to SDB patients, their outcomes were significantly worse when they did get emergently intubated.Conclusions In this large nationally representative sample, despite the increased association of SDB/OSA with postoperative cardiopulmonary complications, the diagnosis of SDB/OSA was negatively, rather than positively, associated with in-hospital mortality and resource use.
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Data about postoperative mortality is mixed but generally shows no increased 30-day mortality, thought to be due to increased monitoring.
“Data about postoperative mortality is mixed but generally shows no increased 30-day mortality, which is thought to be due to increased monitoring in this group of patients.”
From International Consensus Statement on Obstructive Sleep Apnea (2023) · cites this paper as [484]
The Results (Adjusted comparisons; page unavailable) report lower in-hospital mortality among bariatric surgery patients with sleep-disordered breathing. The Discussion (page unavailable) reports that another study found no increase in 30-day mortality, but this paper did not measure 30-day mortality. It does not attribute the mortality finding to increased monitoring; it says the reason is unclear and suggests better postoperative care is unlikely. (LLM, conf=0.88)
Experimental — accuracy not yet measuredMeta-analysis of observational studies suggested that patients with obstructive sleep apnea or related disorders were more likely to sustain atrial fibrillation (OR 1.51, 95% CI 1.36 to 1.69).
“Meta-analysis of observational studies suggested that patients with obstructive sleep apnea or related disorders were more likely to sustain atrial fibrillation (OR 1.51, 95% CI 1.36 to 1.69) or hypoxemia (WMD − 3.8%, 95% CI − 5.4% to − 2.2%) [45–59].”
Meta-analysis of observational studies suggested that patients with obstructive sleep apnea or related disorders were more likely to sustain hypoxemia (WMD −3.8%, 95% CI −5.4% to −2.2%).
“Meta-analysis of observational studies suggested that patients with obstructive sleep apnea or related disorders were more likely to sustain atrial fibrillation (OR 1.51, 95% CI 1.36 to 1.69) or hypoxemia (WMD − 3.8%, 95% CI − 5.4% to − 2.2%) [45–59].”
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- Authors
- Mokhlesi, B., Hovda, M. D., Vekhter, B., Arora, V. M., Chung, F., & Meltzer, D. O.
- Affiliations
- University of Chicago (US)
- University Health Network (CA)
- Corresponding author
- Mokhlesi, Babak
- Venue
- Obesity Surgery
- Published
- 2013-05-22
- Volume
- 23
- Issue
- 11
- Pages
- 1842-1851
- ISSN
- 0960-8923 (ISSN-L)
- 1708-0428
- PMC
- PMC3791320
- OpenAlex
- W2031842037
- Cited by
- 108
- References
- 41
- Citations by year
- 2026: 2 · 2025: 6 · 2024: 1 · 2023: 2 · 2022: 9 · 2021: 5 · 2020: 9 · 2019: 9 · 2018: 10 · 2017: 13 · 2016: 19 · 2015: 13 · 2014: 8 · 2013: 2
- FWCI
- 9.75
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Obesity Surgery (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute on Aging (K23AG033763, K24AG031326)
- National Institute of Diabetes and Digestive and Kidney Diseases (P30DK092949)
- National Center for Research Resources (UL1RR024999)
- Topics
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Airway Management and Intubation Techniques
- Keywords
- sleep-disordered breathing, obstructive sleep apnea
- MeSH terms
- Adult, Emergency Treatment, Female, Health Resources, Humans, Inpatients, Intubation, Intratracheal, Length of Stay, Male, Obesity, Morbid, Respiration, Artificial, Risk Factors, United States, Odds Ratio, Databases, Factual, Treatment Outcome, Hospital Mortality, Risk Assessment, Sleep Apnea, Obstructive, Bariatric Surgery
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