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Chung F., Zhou L., Liao P.
Department of Anesthesia, University Health Network, University of Toronto, Toronto, ON, Canada
BACKGROUND: Continuous home monitoring of oxygen saturation has become a reliable and feasible practice. The objective of this study was to investigate the role of preoperative overnight oximetry in predicting postoperative adverse events.
METHODS: Following research ethics board approval, consented patients underwent a preoperative overnight monitoring of oxygen saturation with a portable oximeter. Parameters from the oximetry data were extracted and their predictive performance for postoperative adverse events was evaluated.
RESULTS: A total of 573 patients were studied with age: 60±12 years and 45% male. Oxygen desaturation index (ODI), cumulative time percentage with SpO2 <90% (CT90) and mean SpO2 were identified as significant predictors for postoperative adverse events. The privilege sensitivity, optimal predictive and privilege specificity cut-offs were: ODI: >3.0 events/h, >9.2 events/h and > 28.5 events/h; CT90: >0.1%, >1.1% and >7.2%; mean SpO2: <96.2%, <94.6% and <92.7%. The odds ratio for corresponding optimal cut-offs was: ODI 1.9 (95% CI: 1.4,2.7); CT90: 1.7 (95% CI: 1.2,2.4) and mean SpO2: 2.7 (95% CI: 1.9,3.8). The patients classified as high risk by ODI or CT90 or mean SpO2 had a significantly higher rate of postoperative adverse events. For ODI >28.5 vs. ODI ≤28.5 events/h, the odds ratio adjusted with age, gender, body mass index and American Society of Anesthesiologists physical status was 2.2 (95% CI: 1.3-3.9).
CONCLUSION: Patients with mean preoperative overnight SpO2 <92.7% or ODI >28.5 events/h or CT90 >7.2% are at higher risk for postoperative adverse events. Overnight oximetry could be a useful tool to stratify patients for the risk of postoperative adverse events.