2017-18 HSC Section 3 Green Book

Research Original Investigation

Complications After Obstructive Sleep Apnea Upper Airway Surgery

Table 1. Patient Characteristics by OSA Severity Defined by the Apnea-Hypopnea Index a

OSA Category

Total (N = 95)

Mild (n = 17)

Moderate (n = 24) 40.4 (2.7)

Severe (n = 54)

Characteristic

P Value

Age, mean (SD), y

37.7 (1.6)

32.8 (1.7)

37.1 (1.3)

.08

Sex

Male

87 (92)

16 (18)

22 (25)

49 (56)

.91

Female

8 (8)

1 (13)

2 (25)

5 (63)

Race/ethnicity Chinese

7 (7) 5 (5)

0 0

3 (43) 1 (20)

4 (57)

Indian Malay

4 (8)

.42

83 (87)

17 (20)

20 (24)

46 (55)

Occupation Executive

2 (2)

1 (50) 4 (27)

0

1 (5) 6 (4)

Professional

15 (16)

5 (33)

Retiree Student Worker

2 (2) 1 (1)

0

0 0

2 (10)

.26

1 (100)

0

75 (79)

11 (15)

19 (25)

45 (6)

Educational level None

2 (2)

0

0

2 (10)

High school

48 (51) 27 (28) 18 (19)

9 (19) 3 (11) 5 (28)

14 (29)

25 (52)

.47

Diploma

5 (19) 5 (28)

19 (7)

College degree or above

8 (44)

BMI, mean (SD) b

32.9 (7.0)

31.6 (9.4)

32.7 (7.0)

33.5 (6.0)

.63

Smoking

Nonsmoker

56 (59) 24 (25) 15 (16)

10 (18)

14 (25)

32 (57)

<10 Cigarettes per day ≥10 Cigarettes per day

4 (17) 3 (20)

8 (33) 2 (13)

12 (5)

.74

10 (67)

Comorbidity None

52 (55) 20 (21)

11 (21)

11 (21)

30 (58)

Hypertension Type 1 diabetes

4 (20) 1 (25) 1 (33)

4 (20) 2 (50)

12 (6)

4 (4) 3 (3)

1 (25) 2 (67) 9 (56)

.34

Other

0

>1 Disease

16 (17)

0

7 (44)

Surgical area Nasal

Abbreviations: BMI, body mass index; IQR, interquartile range; OSA, obstructive sleep apnea. a Data are presented as number (percentage) of patients unless otherwise indicated. Continuous variables were compared using analysis of variance or Kruskal-Wallis test, and categorical variables were compared using the χ 2 or Fisher exact test. b Calculated as weight in kilograms divided by height in meters squared.

5 (5)

0

2 (40)

3 (6)

Palatopharyngeal

33 (35)

9 (27) 1 (25) 7 (13)

10 (30)

14 (42)

.18

Tongue base Combination

4 (4)

2 (50)

1 (25)

53 (56)

10 (19)

36 (68)

Surgery time, mean (SD), min

115.2 (57.6)

109.2 (9.5)

101.0 (9.7)

123.4 (8.9)

.25

Postanesthesia lowest oxygen desaturation, median (IQR), % Perioperative complication None

87.8 (83-93)

93.0 (90-97)

89.0 (83-95)

77.0 (73-82)

.10

47 (49) 48 (51)

6 (13)

16 (34)

25 (53) 29 (60)

.11

At least 1 complication

11 (23)

8 (17) 3 (2-8)

Hospital stay, median (IQR), d

3 (2-6)

3 (2-6)

4 (2-10)

.007

given any complication as the dependent variable ( Table 4 ). Analyseswere also performed separately for pulmonary, surgi- cal, andcardiovascular complications alone. IncreasedBMI and age were associated with increased likelihood of all categories of complications.Within the polysomnographic variables, Lsat and longest apnea duration were associated with significantly higher odds of complications. However, OSA severity category (mild, moderate, or severe) and AHI were not associated with higher oddsof operative complications. Similarly,multilevel op- erationswere not associatedwith increased complication rates compared with a single operation.

Discussion Among the multiple comorbidities associated with upper air- way surgery that may increase perioperative complications, OSA may attract particular attention because it poses further risk of airway obstruction and yet is not intensely looked for duringpreoperative assessments. Toour knowledge, this study represents one of the comprehensive reports examining the effect of OSA diagnosed by strict criteria on the rate of peri- operative complications inmultiple concurrent upper airway

JAMA Otolaryngology–Head & Neck Surgery March 2017 Volume 143, Number 3 (Reprinted)

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