Postoperative cardiorespiratory complications and continuous positive airway pressure efficacy in obese patients undergoing noncardiac surgery

Avinash Gobindram; Jia Lin Jacklyn Yek; Alvin Kah Leong Tan; Yiong Huak Chan; Joyce Lai Ying Lee; Pon Poh Hsu

doi:10.4103/ija.ija_592_21

Postoperative cardiorespiratory complications and continuous positive airway pressure efficacy in obese patients undergoing noncardiac surgery

Indian J Anaesth. 2021 Sep;65(9):676-683. doi: 10.4103/ija.ija_592_21. Epub 2021 Oct 8.

Authors

Avinash Gobindram¹, Jia Lin Jacklyn Yek¹, Alvin Kah Leong Tan², Yiong Huak Chan³, Joyce Lai Ying Lee⁴, Pon Poh Hsu²

Affiliations

¹ Department of Anaesthesia and Surgical Intensive Care, Changi General Hospital, 2 Simei Street 3, Singapore.
² Department of Otorhinolaryngology, Changi General Hospital, 2 Simei Street 3, Singapore.
³ Department of Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, 2 Simei Street 3, Singapore.
⁴ Department of Data Management and Informatics, Changi General Hospital, 2 Simei Street 3, Singapore.

Abstract

Background and aims: One in six Singaporeans has obstructive sleep apnoea (OSA) due to obesity compounded by inherent craniofacial features. We assessed the incidence of cardiopulmonary complications and the effectiveness of continuous positive airway pressure (CPAP) therapy in minimising such complications within an obese population.

Methods: A retrospective study of elective noncardiac surgical patients with a body mass index ≥32 kg/m² was conducted. Patients at moderate to severe risk of OSA were offered CPAP therapy. CPAP therapy adherence, postoperative complications, length of hospital stay, and type of anaesthesia were analysed.

Results: In total, 1400 patients comprising 174 with low risk of OSA (L-OSA) and 1226 with moderate to high risk of OSA were included. Of these, 332 were started on CPAP therapy (C-OSA) while 894 declined CPAP use (R-OSA). There were 10 (0.05%) cardiac events - one (0.6%) in the L-OSA group, six (0.6%) in the R-OSA group and three (0.9%) in the C-OSA group. There were 37 (2.6%) respiratory events - 2 (1.1%) in the L-OSA group, 23 (2.6%) in the R-OSA group, and 12 (3.6%) in the C-OSA group. Multivariate analysis showed no statistical significance in CPAP therapy minimising cardiac (P = 0.147) and respiratory (P = 0.255) complications, when analysed by intention-to-treat. CPAP therapy adherence was 13.6 and 10.2% pre- and postoperatively, respectively. When analysed per protocol, none of the nine patients compliant with both pre- and postoperative CPAP therapy developed cardiopulmonary complications.

Conclusions: Amongst patients with moderate to severe risk of OSA, those who were compliant to perioperative CPAP therapy demonstrated a reduction in cardiopulmonary complications.

Keywords: Continuous positive airway pressure; length of stay; obesity; obstructive; perioperative care; postoperative complications; sleep apnoea.