Impact of Obstructive Sleep Apnea on Orthognathic Surgery Perioperative Outcomes

Hypothesis and Objective: The aim of the study was to examine the association between obstructive sleep apnea (OSA) and (orthognathic surgery) OS outcomes. The null hypothesis is the presence of OSA is not associated with length of hospital stay (LOS) after OS. . Methods: Nationwide Inpatient Sample (NIS), a stratified sample of all hospitalizations in the USA, was used select cases based on ICD-9-CM diagnosis and procedure codes. We identified procedures, patient characteristics, and patient outcomes of all subjects with maxillary and/or mandibular hypoplasia undergoing OS from 2006-2014. A profile of OS patients was created, and a multivariable linear regression model, adjusting for patient and hospital-level confounders, was used to identify risk factors associated with an increased patient LOS. Results: Patient characteristics were consistent with the literature, indicating a predilection for the following characteristics: white, mid-20s, female, maxillary retrognathia, and private insurance coverage. 6.7% of the patients were diagnosed with OSA; patients with OSA were more likely to present with bimaxillary hypoplasia and increased age. While 98.6% of patients were discharged routinely, 20 patients died pre-discharge and 2.5% had complications during the hospital stay. The most common complications were general infection followed by bacterial infection and pneumonia. The linear regression modelidentified the following risk factors associated with an increased LOS: elective surgery (ß=0.5629;p<0.0001), OSA presence (ß=0.4603;p<0.0001), increased comorbidities (ß=0.1434;p<0.0001), Medicaid coverage (ß=0.1542;p<0.0001), and increased osteotomies (ß=0.0715;p<0.0001). The presence of OSA increased LOS by 3.2 days on average. The presence of maxillary hypoplasia, the most common skeletal characteristic, reduced patient LOS (ß=-0.1478;p<0.0001). Conclusions: OSA, which is effectively treated by OS, is associated with a significantly increased LOS. Two of the three most commonly identified comorbidities, hypertension and obesity, are associated with OSA. Our patient profile was consistent with recent studies. Funding: None IRB and/or ACC Protocol #: Exempt