The Impact of Obstructive Sleep Apnea on Clinical, Perioperative, and Cost Outcomes in Patients Who Underwent Posterior Cervical Discectomy and Fusion: A Single Center Retrospective Analysis from 2008 to 2016

Abstract

Abstract INTRODUCTION Obstructive sleep apnea (OSA) is a chronic condition that results from upper airway narrowing during sleep, with an increasing prevalence estimated to be around 9% to 24%. The combination of an unstable, recently fused or immobile cervical spine and OSA may reasonably lead to special considerations, although this topic has not been well studied. METHODS We retrospectively obtained 1191 posterior cervical discectomy and fusion (PCDF) cases, of which 93 subjects (7.81%) had a history of OSA and 1098 subjects (92.19%) did not. The primary outcome selected was prolonged intubation. Secondary outcomes included intensive care unit (ICU) admission, overall complications, extended hospitalization, nonhome discharge, readmission within 30 and 90 d, emergency room visit within 30 and 90 d, and higher total costs. Univariate and multivariate logistic regression analyses were conducted to assess OSA-affected clinical and perioperative outcome measures. RESULTS Compared to the control cohort, the OSA cohort had more subjects with body mass index (BMI) >30 (P < .0001) and ASA status >2 (P < .0001). After controlling for age, sex, obesity, and ASA status, multivariate regression analyses revealed no difference in the odds of a prolonged intubation (P = .4092). However, a difference was noted in the odds of ICU admission (P = .0038), extended hospitalization (P = .0223), and nonhome discharge (P = .0218). Variables predictive of higher direct cost included a higher ASA status (<0.0001), higher Elixhauser Comorbidities Index (ECI) score (P = .004), and more segments involved in the procedure (P < .0001). Conversely, our models suggested that the 2 cohorts did not differ significantly in the odds of increased complications, readmission at 30 and 90 d, and ER visit at 30 or 90 d. CONCLUSION This study is the largest retrospective review, to our knowledge, of patients who have undergone PCDF with a specific focus on OSA. The results from this study suggest that OSA status is an important determinant of primary and secondary clinical outcomes following posterior cervical fusion procedures.