Abstract：
BACKGROUND: Undetected obstructive sleep apnea (OSA) is highly prevalent in patients undergoing bariatric surgery and increases perioperative risks. Screening for OSA using preoperative polygraphy (PG) with subsequent continuous positive airway pressure (CPAP) is costly and time-consuming. Postoperative continuous pulse oximetry (CPOX) is less invasive, and is hypothesized to be a safe and cost-effective alternative.
OBJECTIVE: This nationwide multicenter prospective observational cohort study compared CPOX monitoring with OSA-screening using PG.
METHODS: High-volume bariatric centers.
METHODS: Patients were either postoperatively monitored using CPOX without preoperative OSA-screening, or underwent preoperative PG and CPAP treatment when OSA was diagnosed. Cohort placement was based on local hospital protocols. Cost-effectiveness was analyzed using quality adjusted life years (QALYs) and healthcare costs. Surgical outcomes were also analyzed. Propensity score matching was used in sensitivity analyses.
RESULTS: A total of 1390 patients were included. QALYs were similar between groups at baseline and 1-year postoperatively. Postoperative complications, intensive care unit (ICU)-admissions and admissions, particularly OSA-related, did not differ between groups. Mean costs per patient/year in the CPOX group was €3094 versus €3680 in the PG group; mean difference €-586 (95% CI €-933-€-242). Following propensity score matching, 1090 of 1390 included patients remained, and similar findings for cost-effectiveness, complications, and ICU admissions were observed.
CONCLUSIONS: CPOX monitoring without preoperative OSA-screening was not associated with higher complication or readmission rates compared to PG. CPOX resulted in lower costs from a healthcare perspective and can therefore be considered a cost-effective alternative to routine OSA-screening in patients undergoing bariatric surgery.
OBJECTIVE: This nationwide multicenter prospective observational cohort study compared CPOX monitoring with OSA-screening using PG.
METHODS: High-volume bariatric centers.
METHODS: Patients were either postoperatively monitored using CPOX without preoperative OSA-screening, or underwent preoperative PG and CPAP treatment when OSA was diagnosed. Cohort placement was based on local hospital protocols. Cost-effectiveness was analyzed using quality adjusted life years (QALYs) and healthcare costs. Surgical outcomes were also analyzed. Propensity score matching was used in sensitivity analyses.
RESULTS: A total of 1390 patients were included. QALYs were similar between groups at baseline and 1-year postoperatively. Postoperative complications, intensive care unit (ICU)-admissions and admissions, particularly OSA-related, did not differ between groups. Mean costs per patient/year in the CPOX group was €3094 versus €3680 in the PG group; mean difference €-586 (95% CI €-933-€-242). Following propensity score matching, 1090 of 1390 included patients remained, and similar findings for cost-effectiveness, complications, and ICU admissions were observed.
CONCLUSIONS: CPOX monitoring without preoperative OSA-screening was not associated with higher complication or readmission rates compared to PG. CPOX resulted in lower costs from a healthcare perspective and can therefore be considered a cost-effective alternative to routine OSA-screening in patients undergoing bariatric surgery.
摘要：
背景：未发现的阻塞性睡眠呼吸暂停（OSA）在接受减肥手术的患者中非常普遍，并增加了围手术期风险。使用术前造影（PG）和随后的持续气道正压通气（CPAP）筛查OSA是昂贵且耗时的。术后连续脉搏血氧饱和度（CPOX）侵入性较小，并被认为是一种安全且具有成本效益的替代方案。
目的：这项全国性的多中心前瞻性观察队列研究比较了CPOX监测和使用PG进行OSA筛查。
方法：高容量减肥中心。
方法：患者术后使用CPOX进行监测，没有术前OSA筛查，或在诊断为OSA时接受术前PG和CPAP治疗。队列的放置基于当地医院的协议。使用质量调整生命年(QALYs)和医疗保健成本分析成本效益。还分析了手术结果。在敏感性分析中使用倾向评分匹配。
结果：共纳入1390例患者。基线和术后1年组间的QALY相似。术后并发症,重症监护病房(ICU)-入院和入院，特别是与OSA相关的，组之间没有差异。CPOX组患者/年的平均费用为3094欧元，PG组为3680欧元；平均差异为-586欧元（95%CI-933--242欧元）。在倾向得分匹配之后，1390名患者中的1090名仍然存在，以及类似的成本效益调查结果，并发症,并观察ICU入院情况。
结论：与PG相比，没有术前OSA筛查的CPOX监测与更高的并发症或再入院率无关。从医疗保健的角度来看，CPOX降低了成本，因此可以被认为是接受减肥手术的患者常规OSA筛查的具有成本效益的替代方案。
目的：这项全国性的多中心前瞻性观察队列研究比较了CPOX监测和使用PG进行OSA筛查。
方法：高容量减肥中心。
方法：患者术后使用CPOX进行监测，没有术前OSA筛查，或在诊断为OSA时接受术前PG和CPAP治疗。队列的放置基于当地医院的协议。使用质量调整生命年(QALYs)和医疗保健成本分析成本效益。还分析了手术结果。在敏感性分析中使用倾向评分匹配。
结果：共纳入1390例患者。基线和术后1年组间的QALY相似。术后并发症,重症监护病房(ICU)-入院和入院，特别是与OSA相关的，组之间没有差异。CPOX组患者/年的平均费用为3094欧元，PG组为3680欧元；平均差异为-586欧元（95%CI-933--242欧元）。在倾向得分匹配之后，1390名患者中的1090名仍然存在，以及类似的成本效益调查结果，并发症,并观察ICU入院情况。
结论：与PG相比，没有术前OSA筛查的CPOX监测与更高的并发症或再入院率无关。从医疗保健的角度来看，CPOX降低了成本，因此可以被认为是接受减肥手术的患者常规OSA筛查的具有成本效益的替代方案。
