Friday, September 28, 2018 10:30 AM–12:00 PM abstracts: complications of cervical spine surgery: 160. Obstructive sleep apnea increases the risk of postoperative pulmonary complications following one- or two-level cervical fusion: a retrospective database review study

Abstract

BACKGROUND CONTEXT Anterior Cervical Discectomy and Fusion (ACDF) and Posterior Cervical Fusion (PCF) are surgical techniques for the treatment of degenerative disc disease with established efficacy and safety. However, patients with Obstructive Sleep Apnea (OSA) present with additional risk due to preexisting airway obstruction. Pulmonary complications of patients with OSA who undergo cervical fusion have not been well studied. PURPOSE This study aims to review rates of pulmonary complications following one- or two-level cervical fusion within patients with preexisting OSA. STUDY DESIGN/SETTING Retrospective database study. PATIENT SAMPLE Patients who were diagnosed with OSA within 1 year prior to undergoing one- or two-level ACDFor one- or two-level PCF. OUTCOME MEASURES Postoperative pulmonary complications that developed within three months following surgery, including: bronchitis, bronchiectasis, chronic airway obstruction, lung diseases, dyspnea, respiratory complications, and pneumonia. METHODS The PearlDiver insurance database was queried for Humana patients who were diagnosed with OSA within 1 year prior to undergoing one- or two-level ACDF (CPT-22548, CPT-22551, CPT-22552, CPT-22554, CPT-22585) or one- or two-level PCF (CPT-22590, CPT-22595, CPT-22600, CPT-22614) between 2005 and 2015. The search resulted in 3,748 patients who had OSA prior to ACDF, 24,838 patients who did not have OSA prior to ACDF, 543 patients who had OSA prior to PCF, and 4,034 patients who did not have OSA prior to PCF. Postoperative pulmonary complications that developed within three months following surgery, including: bronchitis, bronchiectasis, chronic airway obstruction, lung diseases, dyspnea, respiratory complications, and pneumonia were then compared between the four groups. RESULTS Patients who were diagnosed with OSA within 1 year prior to undergoing cervical fusion were at a significantly greater risk for developing postoperative pulmonary complications. Patients with OSA who underwent ACDF showed greater rates of chronic airway obstruction 17.4% versus 8.9% (odds ratio [OR]=2.163, p CONCLUSIONS Prior diagnosis of OSA within 1 year prior to patients undergoing one- or two-level cervical fusion is associated with greater rates of postoperative pulmonary complications within three months following surgery. Patients with OSA who underwent ACDF were at a greater risk of developing pulmonary complications than patients with OSA who underwent PCF.