Pre-Operative Assessment Of Obstructive Sleep Apnea In The Ambulatory Anesthesia Patient: A Survey Of Oral And Maxillofacial Surgery Providers

Publication date: Available online 15 January 2019

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Jason M. Goldberg, Michael P. Johnson, Michael J. Safian

Abstract

Purpose

Oral and maxillofacial surgeons (OMS) often treat patients with both diagnosed and undiagnosed obstructive sleep apnea (OSA). Patients with OSA are at significant risk for peri- and post-operative complications after receiving intravenous sedation, general anesthesia, or post-operative opiate analgesia. The purpose of this study was to determine whether OMS providers are screening patients for peri- and post-operative risks related to OSA prior to office-based ambulatory anesthesia.

Materials and Methods

SurveyMonkey software was used to distribute a survey to 1,658 community and hospital based OMS providers in the United States. A response rate of 17.4% (n=288) was achieved. The 27-question survey was created to obtain demographical information and to assess the pre-operative anesthesia routine of the OMS providers. Questions were developed based on ASA guidelines and the STOP-Bang questionnaire to determine the quality and rate of screening for OSA, prior to office based ambulatory anesthesia procedures.

Results

All incomplete survey responses were excluded from analysis. Demographical analysis revealed that 73.61% of the 288 respondents were in private practice only, with no hospital affiliation. 81.88% reported performing <50 hospital operating room procedures per year; while, 81.60% reported performing >200 office based ambulatory anesthesia cases per year. 96.19% reported performing their own office based ambulatory anesthesia. In this cohort, only 34.7% of OMS providers stated that they asked patients OSA-specific screening questions while 74.3% reported asking other pre-operative anesthesia questions (chi-sq=91.0, df=1, p<0.0001).

Conclusions

The majority of surveyed OMS providers are not screening pre-anesthesia patients for OSA using a quantifiable method such as the STOP-Bang questionnaire. These findings identify a need to investigate the rate of undiagnosed OSA syndrome in the OMS office-based ambulatory anesthesia patient population. The STOP-Bang questionnaire may be a useful tool to better assess for anesthesia risk, and modify management accordingly.

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