SAFETY OF A NOVEL SLEEP APNEA TRIAGE TOOL FOR POST-OPERATIVE ORTHOPEDIC SURGERY PATIENTS

SESSION TITLE: Education, Research, and Quality Improvement Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: The purpose of this quality improvement project is to provide a tool for effective and safe triage of post-operative patients in the post-anesthesia care unit with known or suspected obstructive sleep apnea (OSA) at an academic orthopedic hospital in New York City. METHODS: Results are reported from a single center experience in a hospital where there was no standard of care risk assessment tool used in triaging known or suspected OSA patients during the post-operative period. Adult patients who underwent orthopedic surgery between October 2018 and February 2020 who had a known or suspected history of OSA were studied. After admission to the PACU and upon meeting their modified Aldrete criteria or after 2 hours had elapsed, whichever came first, the PACU primary provider used our novel risk-assessment tool to assess whether the patient had high risk criteria related to OSA. Patients without high-risk criteria based on the tool were discharged from the PACU to the general medical/surgical unit. For patients with high-risk criteria, the provider would request critical care consultation in the PACU to determine the patient’s appropriate hospital disposition upon PACU discharge. RESULTS: Over the course of the study period, 216 patients were evaluated using the OSA triage tool. 53.2% of the cohort was male, median BMI was 36.3 kg/m2, 80.1% had prior diagnosis of sleep apnea. Patients had undergone a wide variety of surgeries with 23.6% having undergone hip surgery, 51.4% knee surgery, 13.4% spine surgery, 9.7% shoulder surgery, and 1.9% foot or ankle surgery. Notably, with the use of this tool, only 12.5% of patients met criteria for critical care consult and 91.7% were admitted to the floor from the PACU. Rapid response for respiratory complications were not observed in any of the patients and the three patients that required critical care consult after PACU discharge were related to an acute abdominal issue, tachycardia, and a case of atelectasis. Notably, the anonymous survey was completed by PACU nurse practioners and anesthesiologists and had a 96.8% self-reported satisfaction with guideline implementation tool. CONCLUSIONS: The use of the novel risk assessment tool at NYULMC demonstrated that this tool is a safe and effective method of triaging OSA post-operative patients in the post-anesthesia care unit with known or suspected OSA. Triaging patients using this tool did not result in subsequent rapid responses or mistriage of OSA patients. It allowed for safe care of these patients, reduced critical care resource utilization, and offered a tool perceived to be useful by utilizers. CLINICAL IMPLICATIONS: Implementing the use of this tool in orthopedic patients with obstructive sleep apnea in the post-surgical setting could be an effective and safe means of triaging these patients appropriately without increasing the risk of harm to patients in the post-op period. DISCLOSURES: No relevant relationships by Eric Bondarsky, source=Web Response No relevant relationships by Ezra Dweck, source=Web Response No relevant relationships by Chase Hardwick, source=Web Response No relevant relationships by Bashar Mourad, source=Web Response No relevant relationships by Theresa Reilly, source=Web Response No relevant relationships by Sheeja Schuster, source=Web Response