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October 13, 2018
10/13/2018 1:15:00 PM - 10/13/2018 3:15:00 PM
Room North, Room 20
Preliminary Results from the Society of Anesthesia and Sleep Medicine (SASM) OSA Registry
Karen Posner, Ph.D., Norman Bolden, M.D., Frances F. Chung, M.B.,B.S., Karen B. Domino, M.D.,M.P.H.
University of Washington, Seattle, Washington, United States
Disclosures: K. Posner: None. N. Bolden: None. F.F. Chung: None. K.B. Domino: None.
Introduction: Patients presenting for anesthesia with diagnosed or suspected obstructive sleep apnea (OSA) represent a clinical challenge for perioperative care. Risk of OSA for perioperative mortality is unclear. 1-4 Legal case reviews identified OSA as an important factor in medical malpractice. 5-7

The OSA Death and Near Miss Registry opened in 2014 by the Society of Anesthesia and Sleep Medicine and the Anesthesia Closed Claims Project (CCP) and its Registries (part of AQI). Its goal was to collect a large set of cases, identify recurring patterns related to OSA, and improve patient safety. Preliminary data from 75 case reports of OSA-related adverse events are analyzed.

Methods: Inclusion criteria were age ≥18 yrs; OSA diagnosed or suspected; event occurred after 1992; event within 30 days of surgery and suspected related to OSA: death, brain injury, urgent or emergent ICU transfer, respiratory arrest, Code Blue or ACLS protocol. Case reports had no identifiers. Cases were reported on a detailed data form through the CCP website or collected from malpractice insurers through the CCP. Three authors (NB, FC, KD) evaluated cases for OSA contribution to the adverse event; reliability was assessed by kappa. Cases were grouped by outcome: death or severe brain injury vs. critical events (respiratory arrest or ICU transfer without significant injury). Factors associated with outcomes in postoperative events were compared by Fisher’s exact test and t-test with p<0.05 for statistical significance.

Results: Seventy-seven cases were submitted; 75 were included in the analysis (2 excluded as OSA unlikely to have contributed, kappa = 0.41). OSA was diagnosed in 83% and suspected by screening or history in 17%. Patients were middle-aged (52 ± 15 years), ASA 3 (58%), obese (BMI 38 ± 9); most had inpatient (76%) elective (85%) procedures with general anesthesia (91%).

OSA related events most commonly occurred on the ward (49%); 20% occurred in the PACU, step down unit or ICU, and 19% at home. Events on the ward occurred within 2-64 hrs of anesthesia end time (mean 16 hrs, SD 14); 54% occurred within 12 hrs. Events at home occurred from 3 hrs to 4 days after anesthesia end, with 6 (43%) occurring within 24 hrs. Most patients (76%) were receiving opioids at the time of the event.

Death or severe brain damage occurred in 47 cases (63%) and critical events without significant patient injury in 28 (37%). There were no differences in outcome by age, gender, BMI, ASA physical status, OSA severity for those with diagnostic details, or opioids. Critical events made up most of the postoperative events (67%) occurring in the PACU, step down unit or ICU while death or brain damage was a more common outcome in the ward (62%) or at home (86%, p=0.016). Monitoring on the ward at the time of the event was commonly absent (43%) or intermittent pulse oximetry (35%). Most patients in the PACU, step down or ICU were monitored by continuous pulse oximetry with central monitoring (69%). No patients at home were monitored.

Discussion: Death or severe brain damage associated with OSA was more common in the hospital ward or home, locations with little or no respiratory monitoring. Rescue from OSA-related critical events was more commonly successful in PACU, ICU, or step-down units, locations with higher level monitoring as well as more one-on-one nursing care. Preliminary results from the OSA Death and Near Miss Registry suggest that effective monitoring solutions for the ward and home could potentially reduce perioperative adverse outcomes associated with OSA. Definitive conclusions from the OSA Registry await comprehensive analysis of clinical details.

Acknowledgements: Auckley D, Benumof J, Herway S, Hillman D, Overdyk F, Samuels DJ, Warner L, Weingarten T.

References: 1. Mokhlesi B. Obes Surg 2013. 2. Mokhlesi B. Chest 2013. 3. D’Apuzzo MR. J Arthroplasty 2012. 4. Subramani Y. BJA2017. 5. Fouladpour N. Anesth Analg 2016. 6. Lee L.A. Anesthesiology 2015. 7. Svider PF. Otolaryngol Head Neck Surg 2013.

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