Obstructive sleep apnea: implications for the plastic surgeon and ambulatory surgery centers.

The dynamic growth of surgery in general and plastic surgery in particular has resulted in a greater number of ambulatory surgery centers. The ambulatory surgery center, as well as the plastic surgeon’s office, offers a more streamlined, cost-effective practice setting for the plastic surgeon. With the continued rise of healthcare costs, patients and physicians are electing to utilize ambulatory surgery centers to rein in costs and still deliver high-quality medical care. Because most ambulatory surgery centers and plastic surgeons’ offices are free-standing, proper patient selection is a key factor in maintaining safety. Unfortunately, patient deaths and adverse outcomes related to plastic surgery are currently receiving tremendous attention in the media. Therefore, patient safety issues, while always important to the physician, have now taken a forefront in the media. Meanwhile, patient safety goals and continuous quality improvement are of paramount importance to medicine in general and the outpatient setting in particular. One key issue with significant safety implications for both office-based and ambulatory surgical settings is the rising incidence of obstructive sleep apnea. With the increasing population age and girth, obstructive sleep apnea is an ever-increasing public health burden across the United States. It is largely undiagnosed, yet has significant implications relative to anesthesia risk in the ambulatory surgery center.1 Studies have shown as much as a threefold increase in postoperative morbidity in patients with obstructive sleep apnea versus non-apnea–matched controls undergoing major surgery.2 The plastic surgeon, other surgical practitioners, and the anesthesia team must be acutely aware of the diagnostic criteria and preoperative, intraoperative, and postoperative implications of obstructive sleep apnea in patients undergoing general anesthesia or conscious sedation in the outpatient setting. We will outline the diagnostic criteria for obstructive sleep apnea, discuss perioperative management tools, and review the American Society of Anesthesiologists’ practice guidelines.3