A detailed section on pre-operative assessment of the patient with OSA, screening for OSA, and post-operative management of patients with OSA can be found in Up to Date.
Below are some guidelines useful for St Vincent’s Hospital:
OSA is NOT an indication for post-operative HDU or ICU admission in its own right
- The patient’s co-morbidities and the nature of the surgery will determine the need for HDU
- Patients with OSA having major or high-risk surgery will be seen in PAC-Anaesthesia
- Patients who have had an external sleep study should have those results scanned in to MRO
- All patients with OSA and CPAP should be instructed to bring their CPAP machine in to Hospital with them
- Patients with OSA having major or high-risk surgery (as defined in the Unit Specific Guidelines) should be referred to PAC-Anaesthesia
- Patients with likely undiagnosed OSA (based on clinical assessment – eg the STOP-Bang questionnaire), who are otherwise medically stable and who are having low-risk surgery can proceed to surgery without a sleep study; a plan for assessing and managing their OSA can be organised separately
- Patients having lower limb arthroplasty can be treated in the same way as the low-risk surgery above
- Patients with likely undiagnosed OSA (based on clinical assessment – eg the STOP-Bang questionnaire) having major surgery should be referred to the PO-Sleep Clinic for assessment; The referral should be faxed to 3138 and include details about the urgency of the surgery so that an appropriate appointment can be made; subsequent follow-up will depend on the sleep-study results
- Transthoracic Echocardiogram (TTE) – patients with moderate or severe OSA having major or high-risk surgery will need a pre-operative TTE if one has not been done in the last 2 years. These patients may have pulmonary hypertension that is sub-clinical.