Does Sleep Apnea Increase Surgery Risk?

• By Elisha Bury
• May 01, 2007

Many bariatric surgeons will not operate if a patient does not have his or her sleep apnea under control. The reason is that an apnea event occurring while a patient is under anesthesia or using heavy narcotics after surgery could result in death.

That risk also translates to other surgical procedures. After all, many bariatric patients might also undergo orthopedic surgeries for the hip, shoulder and knee, as well as surgeries to correct cardiovascular complications and other co-morbidities of obesity.

Patients who are unscreened and undiagnosed for sleep apnea are at a greater risk of post-op complications, which creates major liability for hospitals.

So much attention has been given to the role of sleep apnea in surgery, that the American Society of  Anesthesiolo-gists recently issued guidelines recommending that any patient undergoing general anesthesia should be screened for sleep disorders.

“JCAHO earlier this year placed into a recommendation that by January 2008 all of their accrediting hospitals and organizations have to have some pathway identified for patients who have sleep disorders and how they’re going to take care of them before and after surgery,” says Baer.

The reason JCAHO is considering revising their guidelines has a lot to do with liability.

“Some hospitals have faced multi-million dollar lawsuits in which an undiagnosed sleep apnea patient goes in for routine surgery, is discharged with patient-administered painkillers and they die in their sleep,” explains Hillary Theakston, director of communications, ResMed, Poway, Calif.

“As a result, I think the anesthesiology community is coming up to speed pretty rapidly on the risk. The vast majority of sleep apnea patients are undiagnosed, placing them at higher risk for post-operative complications. In addition, the high prevalence of sleep apnea in obese patients means that as obesity rates climb, adverse post-operative events are going to increase with it,” says Theakston.

If the recommendation is put into place, the industry will have to brace for a surge in CPAP demand as many new patients will be uncovered.

“Putting two and two together with the increase in the percentage of the population that is obese, there will be an awful lot of patients who would go through this screening before knee surgery or whatever who would be found to have OSA or other issues,” says Gretchen Jezerc, director of U.S. Marketing for Sleep Disordered Breathing, Respironics. “We as a manufacturer need to work very closely with the whole industry to make sure that we get together to be ready for that and capitalize on that opportunity. Whether it’s that hospitals would be perhaps placing CPAP units in their recovery rooms or however this is going to pan out, each hospital needs to have a plan basically by September of how they’re going to handle this. So, it’s an opportunity for the whole industry to be proactive and organize.”

This article originally appeared in the Respiratory Management May/June 2007 issue of HME Business.