Perioperative Care Of Obstructive Sleep Apnea At A Major Urban Trauma Center

Obstructive Sleep Apnea (OSA) is the most common sleep-related breathing disorder in the United States. OSA affects 25 million adults nationally with as many as 80% of patients potentially undiagnosed (Hines & Marschall, 2018). Early identification with a blue wristband will increase the anesthesia providers’ awareness of OSA-related concerns for potential airway manipulation, prolonged sedation from anesthetic agents, and increased sensitivity to opioids in the post-operative period. This is a Quality Improvement (QI) project using a descriptive design to identify patients with suspected OSA on the day of surgery and examine the clinical practice of providers’ administration of benzodiazepines and opioids to this patient population. The PICOT question is: In patients who are greater than or equal to 18 years old scheduled for elective non-cardiac surgery at a level one trauma medical center (P) how does the implementation of a blue wristband to identify patients with diagnosed or suspected OSA (STOP-Bang score ≥ 4) (I) compared to current practice (C) affect the perioperative management of OSA patients as defined as receiving benzodiazepines alone or in combination with opioids (O) within the perioperative stay (pre-op, intra-op, PACU) (T)? The setting of the project is a surgery center in a major urban medical center. The sample for this project consisted of a total of 100 patients that have undergone elective non-cardiac surgery during the months of August 2022 (pre-implementation) and October through November 2022 (post-implementation). Data was collected via chart review.
Inclusion criteria for both pre- and post-implementation groups were female and male adults greater than or equal to 18 years old scheduled for elective non-cardiac surgery with a STOP-Bang score ≥ 4. Exclusion criteria includes patients younger than 18 years old, emergency surgery, Intensive Care Unit (ICU) admission, or specialized surgeries including trauma, cardiovascular, neurological, and obstetric surgeries. To maintain the confidentiality of data, all patient data collection was de-identified and management was completed via encrypted Excel sheets. This QI project demonstrated that patients with a STOP-Bang score ≥ 4 received nearly the same percentage of benzodiazepines and narcotics whether they were identified with a blue wristband or not.