Association of obstructive sleep apnea with postoperative outcomes after breast reconstruction

BACKGROUND: Obstructive sleep apnea (OSA) is prevalent among breast reconstruction patients, yet its impact on surgical outcomes remains inadequately characterized. This study assessed associations between OSA and postoperative complications, length of stay, and inpatient costs among patients undergoing breast reconstruction. METHODS: We performed a retrospective population-based study using the National Inpatient Sample from 2016 to 2022. Breast reconstruction hospitalizations were identified using ICD-10-PCS procedure codes, and OSA was identified using the ICD-10-CM diagnosis code G47.33. National estimates were generated using HCUP discharge weights, and the complex survey design of the NIS was accounted for in all analyses. Multivariable logistic regression was used to analyze binary postoperative complications. LOS and inpatient costs were summarized as median (interquartile range [IQR]) and compared using the Wilcoxon rank-sum test because of non-normal distributions. A prespecified two-sided P value < 0.001 was considered statistically significant. RESULTS: Based on weighted national estimates, 177,435 adult breast reconstruction hospitalizations were included, of which 7,865 (4.4%) involved patients with OSA. In multivariable-adjusted analyses, OSA was associated with increased odds of respiratory failure (adjusted odds ratio [aOR], 2.705; 95% confidence interval [CI], 2.089-3.504), heart failure (aOR, 2.282; 95% CI, 1.862-2.796), and thrombocytopenia (aOR, 1.552; 95% CI, 1.219-1.976) (all P < 0.001). OSA was also associated with lower odds of seroma (aOR, 0.555; 95% CI, 0.468-0.659). Compared with patients without OSA, those with OSA had a longer LOS (median, 3 [IQR, 2-4] vs. 2 [IQR, 1-3] days; P < 0.001) and higher inpatient costs (median, $99,066 [IQR, $64,118-$144,249] vs. $91,965 [IQR, $60,160-$139,225]; P < 0.001). In subgroup analyses, the associations with respiratory failure, heart failure, and seroma remained directionally consistent across autologous and implant-based reconstruction. CONCLUSIONS: OSA is independently associated with increased cardiopulmonary complications, thrombocytopenia, prolonged hospitalization, and elevated costs in breast reconstruction patients. These findings support routine preoperative OSA screening and optimized perioperative management.