2017-18 HSC Section 3 Green Book

Perioperative Complications in OSA Patients: Legal Analysis

complications are related to cardiorespiratory arrest in an unmonitored setting and difficulty in airway management in the operating room and/or PACU, with both resulting in catastrophic outcomes including death or permanent brain damage. These cases are associated with severe finan- cial penalties. Further research into interventions to reduce postoperative complications is needed. Our data likely underestimate the actual medicolegal burden, given that most such cases are settled out of court, and thus are not accounted for in the legal literature. E DISCLOSURES Name: Nick Fouladpour, MD. Contribution: This author helped design the study, collect the data, and prepare the manuscript. Attestation: Nick Fouladpour reviewed the original data and approved the final manuscript. Name: Rajinish Jesudoss, MD. Contribution: This author helped design the study, collect the data, and prepare the manuscript. Attestation: Rajinish Jesudoss reviewed the original data and approved the final manuscript. Name: Norman Bolden, MD. Contribution: This author helped design the study and prepare the manuscript. Attestation: Norman Bolden approved the final manuscript. Name: Ziad Shaman, MD. Contribution: This author helped analyze the data and prepare the manuscript. Attestation: Ziad Shaman approved the final manuscript. Name: Dennis Auckley, MD. Contribution: This author helped design the study and prepare the manuscript. Attestation: Dennis Auckley reviewed the original data and the analysis of the data, approved the final manuscript, and is also the designated archival author who is responsible for maintaining the study records. This manuscript was handled by: David Hillman, MD. ACKNOWLEDGMENTS The authors thank Mrs. Elizabeth Sparks for help with access- ing the legal databases and the case search. REFERENCES 1. Caples SM, Gami AS, Somers VK. Obstructive sleep apnea. Ann Intern Med 2005;142:187–97 2. Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 1993;328:1230–5 3. Kapur V, Strohl KP, Redline S, Iber C, O’Connor G, Nieto J. Underdiagnosis of sleep apnea syndrome in U.S. communities. Sleep Breath 2002;6:49–54 4. Chung F, Yegneswaran B, Liao P, Chung SA, Vairavanathan S, Islam S, Khajehdehi A, Shapiro CM. Validation of the Berlin questionnaire and American Society of Anesthesiologists checklist as screening tools for obstructive sleep apnea in surgi- cal patients. Anesthesiology 2008;108:822–30 5. Vasu TS, Doghramji K, Cavallazzi R, Grewal R, Hirani A, Leiby B, Markov D, Reiter D, Kraft WK, Witkowski T. Obstructive sleep apnea syndrome and postoperative complications: clini- cal use of the STOP-BANG questionnaire. Arch Otolaryngol Head Neck Surg 2010;136:1020–4 6. Ravesloot MJ, van Maanen JP, HilgevoordAA, van Wagensveld BA, de Vries N. Obstructive sleep apnea is underrecognized and underdiagnosed in patients undergoing bariatric surgery. Eur Arch Otorhinolaryngol 2012;269:1865–71

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