Obstructive Sleep Apnea Increases the Risk of Postoperative Delirium and All-cause Complications After Lumbar Spine Surgery: A Propensity Matched Analysis

Introduction: Obstructive sleep apnea (OSA) has been associated with postoperative delirium, which predisposes patients to major adverse outcomes. In patients undergoing short segment lumbar fusion (1-3 levels), OSA may be associated with acute postoperative delirium. The objective of this study is to determine if preoperative OSA is associated with acute postoperative incident delirium.

Methods: This is a retrospective cohort study of patients who underwent index 1-3 level lumbar fusion between 2010-2022, using the PearlDiver Mariner Database, an all-claims insurance database (120 million patients). Patients were included if they underwent complete preoperative anesthesia assessment, received general anesthesia, and were not delirious preoperatively. Patients with a history of prior lumbar surgery and those undergoing surgery for cancer, trauma, or infection were excluded. 1:1 propensity matching between patients with and without OSA was performed using demographic factors, medical comorbidities, and surgical factors which were significantly associated with delirium in a linear regression model. The primary outcome was Delirium within 7 days of surgery. The secondary outcome was all-cause complications rate (Pneumonia, UTI, all-cause postoperative complications).

Results: Propensity matching created two equal groups of 28,105 patients with and without OSA. Compared to matched patients without OSA, patients with OSA were at a significantly increased risk of developing delirium (RR, 1.29; 95% CI, 1.05–1.57). OSA was also associated with multiple medical complications including pneumonia (RR, 2.13; 95% CI 1.88–2.41), urinary tract infection (RR, 2.10; 95% CI, 1.92–2.30), and overall all-cause medical complications (RR, 1.79; 95% CI, 1.69–1.90).

Conclusion : After risk adjustment, this study found preoperative obstructive sleep apnea significantly increases the risk of postoperative delirium and all-cause complications in patients undergoing 1-3 level lumbar fusion, suggesting that OSA may be a key modifiable risk factor for delirium in this patient population.