Obstructive Sleep Apnea is Associated With Increased Rates of Acute Respiratory Failure, Length of Stay, and Hospital Costs in Patients Undergoing Elective Single-Level Anterior Cervical Discectomy and Fusion

Abstract

Study designRetrospective cohort study.ObjectivesTo examine differences in postoperative complications, recovery course, and costs between patients with and without obstructive sleep apnea (OSA) undergoing single-level anterior cervical discectomy and fusion (ACDF).MethodsThe National Inpatient Sample (NIS) database was queried to identify patients undergoing single-level ACDF between 2016 and 2022. After exclusions, patients were divided into OSA and control groups. Propensity score matching (1:2) controlled for age, sex, obesity, and year of surgery to balance characteristics. Postoperative outcomes, including complications, length of stay (LOS), hospital costs, and discharge disposition, were compared using chi-square tests for categorical variables and t-tests for continuous variables. A Bonferroni correction was applied, with significance set at P < 0.002.ResultsA total of 36,000 matched cases were analyzed (12,000 OSA and 24,000 controls). OSA patients had significantly higher rates of acute respiratory failure (4.7% vs 1.9%; P < 0.001) and mechanical ventilation (1.5% vs 0.6%; P < 0.001). The OSA cohort also had a longer LOS (2.3 vs 1.9 days; P < 0.001), higher hospital costs ($23,300 vs $21,100; P < 0.001), and greater non-routine discharge rates (20.4% vs 16.8%; P < 0.001).ConclusionsOSA is associated with increased respiratory complications, prolonged LOS, and higher costs in single-level ACDF. These findings underscore the importance of preoperative screening and tailored perioperative management to improve outcomes in this high-risk population.