Postoperative Complications in Patients with Unrecognized Obesity Hypoventilation Syndrome Undergoing Elective Non-cardiac Surgery

5.00
Hdl Handle:
http://hdl.handle.net/10757/558500
Title:
Postoperative Complications in Patients with Unrecognized Obesity Hypoventilation Syndrome Undergoing Elective Non-cardiac Surgery
Authors:
Kaw, Roop; Bhateja, Priyanka; Paz y Mar, Hugo; Hernández, Adrian V. ( 0000-0002-9999-4003 ) ; Ramaswamy, Anuradha; Deshpande, Abhishek; Aboussouan, Loutfi S.
Publisher:
American College of Chest Physicians
Journal:
Chest Journal (Chest)
Issue Date:
24-Jun-2015
URI:
http://hdl.handle.net/10757/558500
DOI:
10.1378/chest.14-3216
PubMed ID:
25996642
Additional Links:
http://www.ncbi.nlm.nih.gov/pubmed/25996642
Abstract:
BACKGROUND: Among patients with obstructive sleep apnea (OSA) a higher number of medical morbidities are known to be associated with those that have obesity hypoventilation syndrome (OHS) compared to OSA alone. OHS can therefore pose a higher risk of postoperative complications after elective non-cardiac surgery (NCS) and is often 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 who have OSA alone. METHODS: Patients meeting criteria for OHS were identified within a large cohort of patients 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, AHI). Multivariable logistic or linear regression models were used for dichotomous or continuous outcomes, respectively. RESULTS: Patients with hypercapnia from definite or possible OHS, and overlap syndrome are more likely to develop postoperative respiratory failure [OR: 10.9 (95% CI 3.7-32.3), p<0.0001], postoperative heart failure (p<0.0001), prolonged intubation [OR: 5.4 (95% CI 1.9-15.7), p=0.002), postoperative ICU transfer (OR: 3.8 (95% CI 1.7-8.6), p=0.002]; longer ICU (beta coefficient: 0.86; SE: 0.32, p=0.009) and hospital length of stay (beta coefficient: 2.94; SE: 0.87, p=0.0008) when compared to 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
Type:
info:eu-repo/semantics/article
Rights:
info:eu-repo/semantics/openAccess
Language:
eng
Keywords:
Obesity; Hypoventilation; Surgery
ISSN:
0012-3692
EISSN:
1931-3543

Full metadata record

DC FieldValue Language
dc.contributor.authorKaw, Roopes_PE
dc.contributor.authorBhateja, Priyankaes_PE
dc.contributor.authorPaz y Mar, Hugoes_PE
dc.contributor.authorHernández, Adrian V.es_PE
dc.contributor.authorRamaswamy, Anuradhaes_PE
dc.contributor.authorDeshpande, Abhishekes_PE
dc.contributor.authorAboussouan, Loutfi S.es_PE
dc.date.accessioned2015-06-24T14:41:42Zes_PE
dc.date.available2015-06-24T14:41:42Zes_PE
dc.date.issued2015-06-24es_PE
dc.identifier.issn0012-3692es_PE
dc.identifier.pmid25996642es_PE
dc.identifier.doi10.1378/chest.14-3216es_PE
dc.identifier.urihttp://hdl.handle.net/10757/558500es_PE
dc.description.abstractBACKGROUND: Among patients with obstructive sleep apnea (OSA) a higher number of medical morbidities are known to be associated with those that have obesity hypoventilation syndrome (OHS) compared to OSA alone. OHS can therefore pose a higher risk of postoperative complications after elective non-cardiac surgery (NCS) and is often 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 who have OSA alone. METHODS: Patients meeting criteria for OHS were identified within a large cohort of patients 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, AHI). Multivariable logistic or linear regression models were used for dichotomous or continuous outcomes, respectively. RESULTS: Patients with hypercapnia from definite or possible OHS, and overlap syndrome are more likely to develop postoperative respiratory failure [OR: 10.9 (95% CI 3.7-32.3), p<0.0001], postoperative heart failure (p<0.0001), prolonged intubation [OR: 5.4 (95% CI 1.9-15.7), p=0.002), postoperative ICU transfer (OR: 3.8 (95% CI 1.7-8.6), p=0.002]; longer ICU (beta coefficient: 0.86; SE: 0.32, p=0.009) and hospital length of stay (beta coefficient: 2.94; SE: 0.87, p=0.0008) when compared to 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 NCSeng
dc.formatapplication/pdfes_PE
dc.language.isoenges_PE
dc.publisherAmerican College of Chest Physicianses_PE
dc.relation.urlhttp://www.ncbi.nlm.nih.gov/pubmed/25996642es_PE
dc.rightsinfo:eu-repo/semantics/openAccesses_PE
dc.sourceUniversidad Peruana de Ciencias Aplicadas (UPC)es_PE
dc.sourceRepositorio Académico - UPCes_PE
dc.subjectObesityes_PE
dc.subjectHypoventilationes_PE
dc.subjectSurgeryes_PE
dc.titlePostoperative Complications in Patients with Unrecognized Obesity Hypoventilation Syndrome Undergoing Elective Non-cardiac Surgeryes_PE
dc.typeinfo:eu-repo/semantics/articlees_PE
dc.identifier.eissn1931-3543es_PE
dc.identifier.journalChest Journal (Chest)es_PE
dc.description.peer-reviewRevisión por pareses_PE
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