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Influence of High-Risk for OSA on Outcomes of Open Heart Surgery: A Retrospective Analysis
Cardiothoracic Surgery SESSION TITLE: Cardiothoracic Surgery SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM
Influence of High-Risk for OSA on Outcomes of Open Heart Surgery: A Retrospective Analysis Ajai Rajabalan MD* Rafael Rodriguez MD Samir Patel MD Harmeet Gill MD Diwas Shahi MD Tejwant Singh MD; and Manuel Bautista MD Western Reserve Health Education/NEOMED, Youngstown, OH PURPOSE: There has been an increasing incidence of Obstructive Sleep Apnea (OSA) with increasing obesity. Previous studies shown that OSA increases health care burden by increasing morbidity and mortality, mostly after coronary artery bypass graft surgery (CABG). However, impact of undiagnosed but high-risk for developing OSA on outcomes of CABG were unknown. The aim of our study was to determine the influence of undiagnosed but high risk OSA on length of stay and hospital cost in patients undergoing CABG with or without concomitant valve surgeries. METHODS: After IRB approval, retrospective chart review cohort study of different ethnicities and age group who underwent CABG with and without valve replacement procedures at Northside Medical Center between 2013 and 2015 was performed. Total of 209 patients were identified by excluding previously diagnosed atrial fibrillation, age <18 years and missing information for outcome variables. Total and post-operative length of hospital stay (LOS) and cost of hospitalization were outcomes of the study. We risk-stratified the patients for OSA using age, body mass index, history of snoring, Mallampatti score, COPD, history of OSA and hypertension. We also took into account, any previous history and type of cardiac surgeries. Statistical analysis was performed using SAS 9.4 software with chi-square and Wilcoxon rank sum tests for categorical and continuous variables, respectively.
CONCLUSIONS: The post-operative LOS and the hospitalization cost were significantly higher in high-risk group as compared to low risk group. This study demonstrates that patients with established OSA and at high-risk with factors like advanced age, male sex and previous history of cardiac surgery have prolonged hospital stay and increased health care costs following open heart surgeries. Further larger trials warranted to replicate the results in a larger group of patients. CLINICAL IMPLICATIONS: Patients with already diagnosed OSA should be educated to be compliant with the treatment. High-risk patients should be identified early, screened and managed accordingly. Prior to the major open heart surgeries, such patients should be optimized well enough to lower post-operative morbidity thereby reducing the prolonged hospital stay and cost. DISCLOSURE: The following authors have nothing to disclose: Ajai Rajabalan, Rafael Rodriguez, Samir Patel, Harmeet Gill, Diwas Shahi, Tejwant Singh, Manuel Bautista No Product/Research Disclosure Information DOI:
http://dx.doi.org/10.1016/j.chest.2016.08.036
Copyright ª 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.
journal.publications.chestnet.org
29A
CARDIOTHORACIC SURGERY
RESULTS: Median age of the study population was 67 years with 73% males and 93% Caucasians. In overall population, 85% had hypertension, 70% had coronary artery disease and 45% had obesity. Of the study population, 66%, 19%, and 15% were low risk, high risk for OSA and diagnosed cases of OSA, respectively. Median overall LOS was 10 days, median postoperative LOS was 7 days and median cost of hospitalization was $203,791. We found significantly increased median overall LOS in low, high-risk for OSA and diagnosed OSA (9 vs 10 vs 11 days, p¼0.04). In addition to that, median postoperative LOS was increased in low vs high risk vs diagnosed OSA (7 vs 8 vs 8 days, p¼0.016); and hospitalization cost was also increasing when comparing low vs high risk vs diagnosed OSA ($198601 vs $207934 vs $240046, p¼0.04).
Influence of High-Risk for OSA on Outcomes of Open Heart Surgery: A Retrospective Analysis Ajai Rajabalan MD* Rafael Rodriguez MD Samir Patel MD Harmeet Gill MD Diwas Shahi MD Tejwant Singh MD; and Manuel Bautista MD Western Reserve Health Education/NEOMED, Youngstown, OH PURPOSE: There has been an increasing incidence of Obstructive Sleep Apnea (OSA) with increasing obesity. Previous studies shown that OSA increases health care burden by increasing morbidity and mortality, mostly after coronary artery bypass graft surgery (CABG). However, impact of undiagnosed but high-risk for developing OSA on outcomes of CABG were unknown. The aim of our study was to determine the influence of undiagnosed but high risk OSA on length of stay and hospital cost in patients undergoing CABG with or without concomitant valve surgeries. METHODS: After IRB approval, retrospective chart review cohort study of different ethnicities and age group who underwent CABG with and without valve replacement procedures at Northside Medical Center between 2013 and 2015 was performed. Total of 209 patients were identified by excluding previously diagnosed atrial fibrillation, age <18 years and missing information for outcome variables. Total and post-operative length of hospital stay (LOS) and cost of hospitalization were outcomes of the study. We risk-stratified the patients for OSA using age, body mass index, history of snoring, Mallampatti score, COPD, history of OSA and hypertension. We also took into account, any previous history and type of cardiac surgeries. Statistical analysis was performed using SAS 9.4 software with chi-square and Wilcoxon rank sum tests for categorical and continuous variables, respectively.
CONCLUSIONS: The post-operative LOS and the hospitalization cost were significantly higher in high-risk group as compared to low risk group. This study demonstrates that patients with established OSA and at high-risk with factors like advanced age, male sex and previous history of cardiac surgery have prolonged hospital stay and increased health care costs following open heart surgeries. Further larger trials warranted to replicate the results in a larger group of patients. CLINICAL IMPLICATIONS: Patients with already diagnosed OSA should be educated to be compliant with the treatment. High-risk patients should be identified early, screened and managed accordingly. Prior to the major open heart surgeries, such patients should be optimized well enough to lower post-operative morbidity thereby reducing the prolonged hospital stay and cost. DISCLOSURE: The following authors have nothing to disclose: Ajai Rajabalan, Rafael Rodriguez, Samir Patel, Harmeet Gill, Diwas Shahi, Tejwant Singh, Manuel Bautista No Product/Research Disclosure Information DOI:
http://dx.doi.org/10.1016/j.chest.2016.08.036
Copyright ª 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.
journal.publications.chestnet.org
29A
CARDIOTHORACIC SURGERY
RESULTS: Median age of the study population was 67 years with 73% males and 93% Caucasians. In overall population, 85% had hypertension, 70% had coronary artery disease and 45% had obesity. Of the study population, 66%, 19%, and 15% were low risk, high risk for OSA and diagnosed cases of OSA, respectively. Median overall LOS was 10 days, median postoperative LOS was 7 days and median cost of hospitalization was $203,791. We found significantly increased median overall LOS in low, high-risk for OSA and diagnosed OSA (9 vs 10 vs 11 days, p¼0.04). In addition to that, median postoperative LOS was increased in low vs high risk vs diagnosed OSA (7 vs 8 vs 8 days, p¼0.016); and hospitalization cost was also increasing when comparing low vs high risk vs diagnosed OSA ($198601 vs $207934 vs $240046, p¼0.04).