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Pulmonary complications in trauma patients with obstructive sleep apnea undergoing pelvic or lower limb operation
  1. Michele Fiorentino,
  2. Franchesca Hwang,
  3. Sri Ram Pentakota,
  4. David H Livingston,
  5. Anne C Mosenthal
  1. Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
  1. Correspondence to Dr Michele Fiorentino, Rutgers New Jersey Medical School, Newark, NJ 07103-2714, USA; mf724{at}


Background Obstructive sleep apnea (OSA) is increasingly prevalent in the range of 2% to 24% in the US population. OSA is a well-described predictor of pulmonary complications after elective operation. Yet, data are lacking on its effect after operations for trauma. We hypothesized that OSA is an independent predictor of pulmonary complications in patients undergoing operations for traumatic pelvic/lower limb injuries (PLLI).

Methods Nationwide Inpatient Sample (2009–2013) was queried for International Classification of Diseases, Ninth Revision, Clinical Modification codes for PLLI requiring operation. Elective admissions and those with concurrent traumatic brain injury with moderate to prolonged loss of consciousness were excluded. Outcome measures were pulmonary complications including ventilatory support, ventilator-associated pneumonia, pulmonary embolism (PE), acute respiratory distress syndrome (ARDS), and respiratory failure. Multivariable logistic regression analysis was used, adjusting for OSA, age, sex, race/ethnicity, and specific comorbidities (obesity, chronic lung disease, and pulmonary circulatory disease). P<0.01 was considered statistically significant.

Results Among the 337 333 patients undergoing PLLI operation 3.0% had diagnosed OSA. Patients with OSA had more comorbidities and were more frequently discharged to facilities. Median length of stay was longer in the OSA group (5 vs 4 days, p<0.001). Pulmonary complications were more frequent in those with OSA. Multivariable logistic regression showed that OSA was an independent predictor of ventilatory support (adjusted odds ratio (aOR), 1.37; 95% CI,1.24 to 1.51), PE (aOR 1.40; 95% CI, 1.15 to 1.70), ARDS (aOR 1.36; 95% CI,1.23 to 1.52), and respiratory failure (aOR 1.90; 95% CI, 1.74 to 2.06).

Conclusion OSA is an independent and underappreciated predictor of pulmonary complications in those undergoing emergency surgery for PLLI. More aggressive screening and identification of OSA in trauma patients undergoing operation are necessary to provide closer perioperative monitoring and interventions to reduce pulmonary complications and improve outcomes.

Level of evidence Prognostic Level IV.

  • apnea
  • postoperative complications

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  • Presented at This work was presented at Academic Surgical Congress 2018 in Jacksonville, Florida.

  • Contributors MF, FH, and ACM participated in the literature search. FH, SRP, DHL, and ACM participated in study design. FH participated in data collection. MF, FH, SRP, DHL, and ACM participated in data analysis. MF, FH, SRP, DHL, and ACM participated in data interpretation. MF, FH, and SRP participated in writing. MF, FH, SRP, DHL, and ACM participated in critical revision.

  • Funding Support for this publication was provided by the Auen Foundation (MF and FH Grant Numbers A18-63/A16-88).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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