When the Society for Ambulatory Anesthesia released its consensus statement on preoperative selection of patients with obstructive sleep apnea (OSA), it recommended that ambulatory surgery centers instruct patients on continuous positive airway pressure (CPAP) to bring their devices on their day of surgery (Anesth Analg 2012;115:1060-1068). Now, a survey by a Texas research team has shown that some 60% of facilities follow the recommendations, with more reporting that they have a device on hand, should it become necessary.
“Sleep apnea is a very real phenomenon that we have to deal with in ambulatory surgery, especially because we’re trying to reduce postoperative complications and not have patients go to the hospital afterwards,” said Amin Alishahi, MD, a resident at the University of Texas Southwestern Medical Center, in Dallas.
“As we know, CPAP can improve hypoxic episodes and minimize complications. So we wanted to see how ambulatory surgical centers are adhering to the guidelines in today’s practice.”
To help shed light on this issue, surveys were distributed via email to medical directors of busy ambulatory surgery centers throughout the United States. Reminder emails were sent if no response was received within a month.
Survey response was 60.9% (67/110), Dr. Alishahi reported at the 2016 annual meeting of the International Anesthesia Research Society (abstract S-24). According to demographic data provided, the survey results comprise 408,147 cases among 1,946 providers. Of these, 59.7% of facilities (40/67) require patients to bring their CPAP devices on the day of surgery. What’s more, only 25.37% (17/67) reported using a CPAP machine postoperatively in the previous two years. The highest reported CPAP use was 20 times over the two-year period.
“Surprisingly, 100% of all centers in the study accept OSA patients,” Dr. Alishahi said.
Yet as Dr. Alishahi explained, there may be a good reason why some centers do not require their patients to bring their CPAP devices on the day of surgery.
“In looking at the comments we received, it seems that some anesthesia groups didn’t feel like they needed to require their patients to do so,” he said. “The second thing is that some centers said they had a CPAP device available, if needed.”
These results align with comments the society received after the consensus statement was published, according to Girish Joshi, MD, co-investigator and professor of anesthesiology and pain medicine at the University of Texas Southwestern Medical Center.
“After development of the guidelines, we sent them off to big practices because we wanted their opinion on the recommendations,” Dr. Joshi said. “The feedback they offered was that patients don’t necessarily need to bring their CPAP [devices] because the centers are so good at choosing the right patients for the right procedures.
“Luckily for us,” Dr. Joshi added, “obstructive sleep apnea is fairly well taken care of in the ambulatory setting.”
Nevertheless, the investigators acknowledged that prospective studies are needed to assess postoperative respiratory complications that may necessitate the need for CPAP use in this setting.
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