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

A Sankar; W S Beattie; G Tait; D N Wijeysundera

doi:10.1016/j.bja.2018.10.059

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

Br J Anaesth. 2019 Feb;122(2):255-262. doi: 10.1016/j.bja.2018.10.059. Epub 2018 Dec 11.

Authors

A Sankar¹, W S Beattie², G Tait², D N Wijeysundera³

Affiliations

¹ Department of Anesthesia, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
² Department of Anesthesia, University of Toronto, Toronto, ON, Canada; Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada.
³ Department of Anesthesia, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada; Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada. Electronic address: d.wijeysundera@utoronto.ca.

PMID: 30686311
DOI: 10.1016/j.bja.2018.10.059

Abstract

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.

Keywords: STOP-BANG; perioperative outcome; questionnaires; sleep apnoea, obstructive; surgical procedures; surveys; validation.

Publication types

Validation Study

MeSH terms

Aged
Cohort Studies
Comorbidity
Cross-Sectional Studies
Elective Surgical Procedures / methods*
Elective Surgical Procedures / mortality
Female
Heart Diseases / epidemiology
Humans
Length of Stay
Male
Middle Aged
Postoperative Complications / epidemiology
Predictive Value of Tests
Reproducibility of Results
Retrospective Studies
Risk Assessment
Risk Factors
Sleep Apnea, Obstructive / complications
Sleep Apnea, Obstructive / diagnosis*
Surveys and Questionnaires*