P050 Integrating a same day sleep apnoea assessment into a surgical pre-admission clinic (PAC)

Abstract Introduction Untreated obstructive sleep apnoea (OSA) is often unrecognised pre-operatively and is associated with increased post-operative complications and morbidity. Anaesthetist screening of OSA risk in pre-admission clinic (PAC) prompts referral to a sleep physician to investigate. Aim To explore the novel concept of integrating a sleep physician into PAC. Methods An audit sampling a PAC service was conducted at a tertiary hospital, pre and post integration of a sleep physician into PAC. Pre-integration, anaesthetists who identified patients at risk of OSA based on STOPBANG questionnaire were referred to the sleep clinic on a future date. Post integration, such patients were referred to the sleep physician in PAC on the same day. Demographic variables, times to assessments and hospital outcomes were reviewed. Results 382 patients were reviewed in PAC pre-integration (26% bariatric, 31% orthopaedic, 43% other) and 355 post-integration (16% bariatric, 39% orthopaedic, 45% other). Comparing pre-integration with post-integration: 8 (2%) vs 71 (20%) patients were referred for sleep physician assessment. Mean days to: sleep physician assessment (120 vs 0), sleep study (91 vs 25), OSA management (138 vs 13) and surgery (261 vs 38). The 30-day mortality and unplanned non-invasive ventilation (NIV) post-operatively did not occur in either group referred for sleep assessment. Discussion Integration of a sleep physician into PAC resulted in 10 times more referrals for assessment of OSA. Time to: see a sleep physician, sleep study, management and surgery was reduced. Limitations of this study include a small sample size and confounders affecting clinical wait times.