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Orthopedic surgery in patients with OSA

Arlene J Hudson, Robert J Walter, John Flynn, Dale F Szpisjak, Cara Olsen, Matthew Rodgers, Vincent F Capaldi, Brent McDuffie, Christopher J Lettieri
STUDY OBJECTIVES: The presence of obstructive sleep apnea (OSA) in ambulatory surgical patients causes significant perioperative concern; however, few data exist to guide clinicians' management decisions. The objective of this study was to measure changes in perioperative sleep parameters among an ambulatory surgery population. METHODS: This study is a prospective, observational study of ambulatory patients undergoing orthopedic surgery on an extremity. Study subjects completed three unattended home sleep apnea tests: baseline before surgery, the first night after surgery (N1), and third night after surgery (N3)...
April 15, 2018: Journal of Clinical Sleep Medicine: JCSM: Official Publication of the American Academy of Sleep Medicine
M Melanie Lyons, Brendan T Keenan, Junxin Li, Tanya Khan, Nabil Elkassabany, Colleen M Walsh, Noel N Williams, Allan I Pack, Indira Gurubhagavatula
Study Objective: To validate that the symptomless Multi-Variable Apnea Prediction index (sMVAP) is associated with Obstructive Sleep Apnea (OSA) diagnosis and assess the relationship between sMVAP and adverse outcomes in patients having elective surgery. We also compare associations between Bariatric surgery, where preoperative screening for OSA risk is mandatory, and non-Bariatric surgery groups who are not screened routinely for OSA. Methods: Using data from 40 432 elective inpatient surgeries, we used logistic regression to determine the relationship between sMVAP and previous OSA, current hypertension, and postoperative complications: extended length of stay (ELOS), intensive-care-unit-stay (ICU-stay), and respiratory complications (pulmonary embolism, acute respiratory distress syndrome, and/or aspiration pneumonia)...
March 1, 2017: Sleep
Roman Melamed, Lori L Boland, James P Normington, Rebecca M Prenevost, Lindsay Y Hur, Leslie F Maynard, Molly A McNaughton, Tyler G Kinzy, Adnan Masood, Mehdi Dastrange, Joseph A Huguelet
BACKGROUND: Postoperative pulmonary complications in orthopedic surgery patients have been associated with worse clinical outcomes. Identifying patients with respiratory risk factors requiring enhanced monitoring and management modifications is an important part of postoperative care. Patients with unanticipated respiratory decompensation requiring transfer to the intensive care unit (ICU) have not been studied in sufficient detail. METHODS: A retrospective case-control study of elective orthopedic surgery patients (knee, hip, shoulder, or spine, n = 51) who developed unanticipated respiratory failure (RF) necessitating transfer to the ICU over a 3-year period was conducted...
2016: Perioperative Medicine
Amanda Whippey, Gregory Kostandoff, Heung K Ma, Ji Cheng, Lehana Thabane, James Paul
BACKGROUND: Ambulatory surgery plays an important role in pediatric anesthesia. However, it is difficult to predict which patients will experience complications. Age >80, ASA class 3 or 4, duration of surgery >3 h, and BMI 30-35 are independent predictors of unanticipated admission in adults. In this study, we retrospectively evaluate risk factors for unanticipated admission, following ambulatory surgery in children. METHODS: All ambulatory patients requiring unanticipated admission between 2005 and 2013 were compared to a random sample of patients not requiring admission in this case-control study...
August 2016: Paediatric Anaesthesia
Michael K Urban, Michele Mangini-Vendel, Stephen Lyman, Ting Jung Pan, Steven K Magid
BACKGROUND: The goal of elective orthopedic surgery is to return patients to their expected level of activity without an increased incidence of postoperative complications. The first step is identifying patient and/or surgical characteristics responsible for these complications. QUESTIONS/PURPOSES: This study sought to identify predictors of a step-up in medical care after non-ambulatory elective orthopedic surgery. METHODS: At a single specialty orthopedic hospital, we identified all in-hospital postoperative patients who were transferred to a higher level of medical care ((PACU) post-anesthesia care unit)...
February 2016: HSS Journal: the Musculoskeletal Journal of Hospital for Special Surgery
A P Huet, C Paulus
The obstructive sleep apnea syndrome (OSAS) may affect children, especially those with dentofacial disharmonies. Dentofacial orthopedic (DFO) treatments carried out in those patients must take this condition into account and can, in selected cases, improve or even treat the OSAS. The goal of our work was to report our experience about DFO treatments of children affected by OSAS in the department of maxillofacial surgery of Femme-Mère-Enfant hospital of university hospitals of Lyon, France.
September 2015: Revue de Stomatologie, de Chirurgie Maxillo-faciale et de Chirurgie Orale
Osa Emohare, Charles G Ledonio, Brian W Hill, Rick A Davis, David W Polly, Matthew M Kang
BACKGROUND CONTEXT: Recent studies have shown that prophylactic use of intrawound vancomycin in posterior instrumented spine surgery substantially decreases the incidence of wound infections requiring repeat surgery. Significant cost savings are thought to be associated with the use of vancomycin in this setting. PURPOSE: To elucidate cost savings associated with the use of intrawound vancomycin in posterior spinal surgeries using a budget-impact model. STUDY DESIGN: Retrospective cohort study...
November 1, 2014: Spine Journal: Official Journal of the North American Spine Society
Pu Liao, Quanwei Luo, Hisham Elsaid, Weimin Kang, Colin M Shapiro, Frances Chung
BACKGROUND: Obstructive sleep apnea (OSA) may worsen postoperatively. The objective of this randomized open-label trial is to determine whether perioperative auto-titrated continuous positive airway pressure (APAP) treatment decreases postoperative apnea hypopnea index (AHI) and improves oxygenation in patients with moderate and severe OSA. METHODS: The consented patients with AHI of more than 15 events/h on preoperative polysomnography were randomized into the APAP or control group (receiving routine care)...
October 2013: Anesthesiology
Babak Mokhlesi, Margaret D Hovda, Benjamin Vekhter, Vineet M Arora, Frances Chung, David O Meltzer
BACKGROUND: Systematic screening and treatment of sleep-disordered breathing (SDB) or obstructive sleep apnea (OSA) in presurgical patients would impose a significant cost burden; therefore, it is important to understand whether SDB is associated with worse postoperative outcomes. We sought to determine the impact of SDB on postoperative outcomes in patients undergoing four specific categories of elective surgery (orthopedic, prostate, abdominal, and cardiovascular). The primary outcomes were in-hospital death, total charges, and length of stay (LOS)...
September 2013: Chest
Dmitry Nepomnayshy, Walid Hesham, Brandon Erickson, Julie MacDonald, Richard Iorio, David Brams
BACKGROUND: Because perioperative complications of unrecognized obstructive sleep apnea (OSA) can be severe, many bariatric surgery programs routinely screen all patients. However, many obese non-bariatric surgery patients do not get screened. We wanted to evaluate the need for routine preoperative OSA screening. METHODS: Morbidly obese patients with a body mass index (BMI) > 40 kg/m(2) undergoing bariatric surgery--all screened for OSA--were compared to morbidly obese orthopedic lower extremity total joint replacements (TJR) patients--not screened for OSA...
March 2013: Obesity Surgery
Spencer S Liu, Mary F Chisholm, Raymond S John, Justin Ngeow, Yan Ma, Stavros G Memtsoudis
BACKGROUND: It is unclear when it is safe to discharge patients with a diagnosis of Obstructive Sleep Apnea (OSA) after ambulatory surgical procedures due to concern for postoperative respiratory compromise and hypoxemia. Our OSA patients undergoing ambulatory-type orthopedic procedures are monitored overnight in the PACU, thus we reviewed patient records to determine incidence of complications. METHODS: Two hundred and six charts of patients with preoperative diagnosis of OSA based on ICD-9 codes were reviewed for outcomes including episodes of hypoxemia...
2010: Patient Safety in Surgery
I Dudkiewicz, S Velkes, A Oran, M Pritsch, M Salai
Treatment of osteosarcoma (OSA) of the proximal humerus poses many difficulties and challenges to the treating team. Between 1993 and 2000, we treated 11 patients (three women, eight men; age range, 17-74 years) suffering from OSA of the proximal humerus by 'composite': massive allografts and long humeral prosthesis. At presentation, 10 patients were at stage 2-B and one at stage 3-B of OSA. One patient presented with a pathologic fracture. All patients except patient No. 6, received preoperative chemotherapy followed by limb salvage surgery and postoperative chemotherapy...
2003: Cell and Tissue Banking
Mark M Harrison, Aaron Childs, Patricia E Carson
We investigated the frequency of undiagnosed sleep apnea in patients scheduled for elective total joint arthroplasty. Two hundred fifty-four patients were assessed between September 1999 and May 2001. At intake, patients were given a standard systems review with the addition of targeted questions about sleep apnea. Ten patients reported symptoms consistent with undiagnosed obstructive sleep apnea (OSA). The identification of undiagnosed OSA is an issue for orthopedic practice because many patients referred to an arthroplasty service for hip and/or knee surgeries are obese...
December 2003: Journal of Arthroplasty
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