VESS01 - Patients with Sleep Apnea Undergoing Carotid Endarterectomy are at Greater Risk of Postoperative Complications: A Nationwide Analysis

Objectives: Sleep apnea (SA) has been shown to lead to daytime somnolence, cognitive impairment, worsened immunity, and decreased bone mineralization. The effects of SA on carotid endarterectomy (CEA) outcomes are not well defined. The purpose of this study is to assess 30 and 90-day complication and mortality rates in patients with and without SA undergoing CEA.

Methods: A retrospective review of a private insurance claims database was conducted from 2010 to 2021. All cases of CEA and those with a prior diagnosis of SA were identified using their corresponding diagnosis and procedural codes. Patients undergoing CEA with a diagnosis of SA were matched to control patients 1:3 based on age, gender, and Elixhauser Comorbidity Index. Outcomes assessed were 30 and 90-day rates of myocardial infarction, cerebrovascular accident, pneumonia, deep vein thrombosis, pulmonary embolism, urinary tract infection, falls, sepsis, acute kidney injury, transfusion, hematoma, surgical site infection, and wound complications. The results of the matching process were successful, with no differences seen between cohorts in regards to age, gender, or comorbidity burdens.

Results: A total of 33,123 SA patients were matched to 99,292 control patients. The SA group had significantly higher rates of all 30-day medical complications when compared to the control group (all p< 0.01). The greatest increased odds were in that of falls (OR 4.07, CI 3.52-4.70) and pulmonary embolism (OR 2.76, CI 2.04-3.74). The SA group likewise had significantly higher rates of all 90-day medical complications when compared to the control group (all p< 0.01). The greatest increased odds were in that of falls (OR 3.23, CI 2.93-3.56), urinary tract infection (OR 2.48, CI 2.33-2.63), and myocardial infarction (OR 2.43, CI 2.33-2.63). Patient with SA who underwent CEA also had an over 4-fold increase in odds of mortality within 30-days, and nearly 3-fold increase within 90-days postoperatively.

Conclusions: Sleep apnea in patients undergoing CEA is associated with significant risk of medical complications, especially falls, pulmonary complications, and myocardial infarction. Patients also had a significant increase in odds of mortality within 30 and 90-days. It is prudent for vascular surgeons to identify those with SA, with possible early intervention prior to surgery to improve outcomes.