Preoperative STOP-BANG Scores and Postoperative Delirium and Coma in Thoracic Surgery Patients

Abstract

Background Obstructive sleep apnea (OSA) is associated with higher rates of postoperative delirium. The relationship between preoperative OSA risk and postoperative delirium and coma in thoracic surgery patients hospitalized in the intensive care unit (ICU) is not well understood. This study tests the hypothesis that thoracic surgery patients hospitalized in ICU with a higher preoperative risk for OSA are more likely to develop postoperative delirium and coma, resulting in longer hospital stays.

Methods Preoperative OSA risk was measured using the STOP-BANG questionnaire. STOP-BANG scores of ≥ 3 were defined as intermediate-high risk for OSA. 128 patients who underwent major thoracic surgery completed the STOP-BANG questionnaire preoperatively. The Richmond Agitation and Sedation Scale was used to assess level of consciousness. The Confusion Assessment Method for the ICU was used to assess for delirium. Linear regression was used to assess the relationship between risk of OSA and outcome measures. Results were adjusted for age, gender, body mass index, Charlson Comorbidity Index, instrumental activities of daily living, and surgery type.

Results 96 out of 128 patients (76%) were in the intermediate-high risk OSA group. Adjusted analyses showed that the intermediate-high risk OSA group had a longer duration of postoperative ICU delirium and coma compared to the low risk OSA group (1.4 days ± 1.3 vs 0.9 days ± 1.4; P = 0.04). Total number of hospital days was not significantly different.

Conclusions Higher preoperative risk for OSA in thoracic surgery patients was associated with a longer duration of postoperative delirium and coma.