Evaluation of validity of the STOP-BANG questionnaire in major elective noncardiac surgery

Jan 29, 2019British journal of anaesthesia

How accurate the STOP-BANG questionnaire is for major non-heart surgeries

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Abstract

Of 26,068 patients, 58% were classified as low-risk for obstructive sleep apnoea (OSA) using the STOP-BANG questionnaire.

The proportion of patients with diagnosed OSA was 4% in the low-risk group, 12% in the intermediate-risk group, and 44% in the high-risk group.
Correlations between STOP-BANG scores and other health assessments were weak, with the strongest being a correlation of 0.28 with ASA Physical Status.
Despite being classified into different risk strata, STOP-BANG scores were not associated with 30-day mortality or cardiac complications after adjusting for other risk factors.
The findings suggest that while the STOP-BANG questionnaire has some validity in categorizing patients, it may not be a reliable predictor of postoperative outcomes.

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BACKGROUND: The STOP-BANG questionnaire screens for obstructive sleep apnoea (OSA) in surgical patients. In prior research, the association of STOP-BANG scores with comorbidities and outcomes was inconsistent. The objective of this study was to evaluate the validity of the STOP-BANG score.

METHODS: We conducted a retrospective cohort study of patients undergoing major elective noncardiac surgery at the University Health Network (Toronto, ON, Canada) between 2011 and 2015. Cross-sectional construct validity was evaluated based on proportions with diagnosed OSA across STOP-BANG strata. Concurrent construct validity was assessed based on the correlation of STOP-BANG with ASA Physical Status (ASA-PS), the Revised Cardiac Risk Index, and the Charlson Comorbidity Index. Predictive validity was assessed based on the adjusted associations of STOP-BANG risk with 30-day mortality (logistic regression), cardiac complications (logistic regression), and length-of-stay (negative binomial regression).

RESULTS: Of 26 068 patients in the cohort, 58% were in the low-risk STOP-BANG stratum, 23% in the intermediate-risk stratum, and 19% in the high-risk stratum. The proportion with previously diagnosed OSA was 4% (n=615) in the low-risk stratum, 12% (n=740) in the intermediate-risk stratum, and 44% (n=2142) in the high-risk stratum. The correlations of STOP-BANG with ASA-PS (Spearman ρ=0.28), Revised Cardiac Risk Index (ρ=0.24), and Charlson Comorbidity Index (ρ=0.10) were weak, albeit statistically significant (P<0.001). After risk-adjustment, STOP-BANG risk strata were not associated with 30-day mortality, cardiac complications, or length-of-stay.

CONCLUSIONS: The STOP-BANG questionnaire has modest construct validity but did not predict postoperative mortality, hospital length-of-stay, or cardiac complications.

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Evaluation of validity of the STOP-BANG questionnaire in major elective noncardiac surgery

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