Impact of Obstructive Sleep Apnea on Outcomes after Anterior Cervical Discectomy and Fusion

Study Design. Retrospective Cohort Objective. To evaluate the impact of having a history of Obstructive Sleep Apnea (OSA) in patients undergoing anterior cervical discectomy and fusion (ACDF) on postoperative outcomes. Summary of Background Data. With an aging population and rates of obesity increasing, comorbidities that influence patient safety are increasingly common. One frequently overlooked comorbidity is OSA which affects nearly 24% of the population. Despite its prevalence, the impact of OSA on outcomes following ACDF is poorly understood. Methods. A retrospective analysis of patients >18 years who underwent 1-4 level ACDF at an academic medical center from 2014-2020 was performed. Patient’s age, sex, BMI, CCI, hypertension, diabetes, and levels fused were propensity matched in a 3:1 fashion. Outcomes assessed included inpatient complications, 30 and 90-day ED visits, 30 and 90-day readmissions, reoperations, and one-year PROMs. Results. A total of 344 ACDF patients (86 OSA, 258 No OSA) were included. 30-day ED visits were higher among the OSA compared to the non-OSA group (5.85% vs 0%, P =0.001). Among ED visits, there were 2 patients with pneumonia, 1 with dysphagia, and 1 with extremity weakness, none of which warranted readmission. ED visits equalized in the 30–90-day window. There were no significant differences in inpatient complications, LOS, discharge disposition, readmissions, reoperations, and one-year PROMs. Conclusion. Patients with a history of OSA underwent ACDF without an increased risk of postoperative complications, readmissions, or reoperations and experienced a complication rate much lower than previously suggested by current literature. OSA patients experienced similar improvements in PROMs at 1-year follow-up. Surgeons should counsel OSA patients regarding the increased risk of 30-day ED visits. But overall, patients can expect safe and equivalent outcomes compared to non-OSA patients which lends support for safe outpatient surgery in this population.