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How Dangerous Is Obstructive Sleep Apnea During Surgery?


If OSA poses a risk to patients undergoing surgery, what should surgeons and anaesthesiologists do to reduce it? The trouble is that nobody knows yet. There are various suggestions such as that patients should undergo screening for ASO before operation and that they should be more closely monitored than others, and for longer, after operation. People with ASO who would otherwise be day cases should be admitted overnight. Perhaps they should receive treatment beforehand such as positive airway pressure therapy (PAP). But no one knows for how long they should receive it or even whether it would reduce postoperative risk. All that is really known is that something must be done.

That something is sure to be expensive, and one of the reasons something must be done is the threat of legal action. Doctors and hospitals might be held responsible for post-operative complications in patients with OSA if they did nothing to try to prevent them, even if it is not known scientifically what exactly they should have done to prevent them. This seems to me completely mad: first the sentence, then the verdict. What would be prevented by preventive treatment, therefore, are not medical complications but legal ones.

The authors conclude their article as follows:

Until we can better identify patients who are at risk and evidence-based interventions that improve outcomes… institutions should, at the very least, address the issue of OSA and develop protocols that take into account the need for heightened awareness as well as locally available resources.

This is a pure example of the something-must-be-done-ism that is epidemic – I use the term loosely or metaphorically – in political life. And what must be done is always to spend more and drive up costs.


image courtesy shutterstock /  Claudio Divizia / Paul Vasarhelyi