An article published on OSA and the risk it places on positive postoperative outcomes was published in the September 2007 issue of the
Pennsylvania Patient Safety Advisory. Analysis was performed on about 250 reports in which OSA was identified over approximately three years. About 20% of these reports were classified as Serious Events, including three deaths. The article indicated that sleep apnea was present in the medical history in the majority of the reports.
In 2014, an
Advisory article discussed analysis of events from January 2009 through 2013.
Analysis of event reports showed a downward trend, with 27 OSA-related events occurring in 2009, 23 in 2010, 20 in 2011, 14 in 2012, and 15 in 2013. Review of the event narratives suggests OSA conditions that are not detected during the preoperative screening and assessment process may place patients at increased risk for postoperative complications.
Seven issues of concern when OSA was diagnosed during the perioperative or postoperative periods were identified:
- Cancellation on the day of surgery
- Extended length of stay in the postanesthesia care unit (PACU)
- Postoperative reintubation
- Postoperative transfer from ambulatory care center to acute care for further treatment
- Undiagnosed sleep apnea contributing to cardiac arrest
- Unplanned ICU admission
- Use of reversal agents following narcotic administration
A critical element in reducing the risk of surgical complications for OSA patients is the initial preoperative screening evaluation. The preoperative evaluation includes review of previous medical records, an interview with the patient and/or family, and a physical examination. The following figure illustrates blocked airway associated with OSA, compared to normal breathing during sleep.
Figure. Anatomy of Obstructive Sleep Apnea
Excerpted from: Wallace SC. Assessment tools help diagnose obstructive sleep apnea. Pa Patient Saf Advis 2014 Dec. http://patientsafety.pa.gov/ADVISORIES/Pages/201412_168.aspx.