2017-18 HSC Section 3 Green Book

Original Investigation Research

Complications After Obstructive Sleep Apnea Upper Airway Surgery

Table 2. Incidence of Complications

Table 3. Potential Risk Factors in Those With and Without Complications a

No Complications (n = 47)

Complications (n = 48)

No. (%) of Patients

Risk Factor

P Value

Within 2-30 Postoperative Days

Immediately Postoperative (Day 1)

Age, mean (SD), y

39.3 (1.7)

35.1 (1.3)

.05

Total (N = 95)

Intra- operative

Complication

Sex

No complication 47 (49)

60 35

70 25

87

Male

42 (48)

45 (52)

.44

At least 1 complication

48 (51)

8

Female

5 (63)

3 (38)

BMI, mean (SD) b

31.3 (1.0)

34.5 (1.0)

.02

Surgery related a Bleeding

Comorbidity None

12

5 0

2 5

5 0

22 (42)

30 (58) 11 (55)

5

Surgical wound breakdown Surgery site infection

Hypertension Type 1 diabetes

9 (45)

4 (100) 3 (100)

0 0

.07

2

0

0

2

Other

Total

19 (20)

5 (14)

7 (28)

7 (88)

>1 Disease

9 (56)

7 (44)

Pulmonary related a

Smoking

Nonsmoker

26 (46) 17 (71)

30 (54)

Bronchospasm 9

9 9 0

0 0 9

0 0 0

<10 Cigarettes per day ≥10 Cigarettes per day

7 (29)

Atelectasis CPAP or BiPAP intervention Tracheal reintubation Respiratory arrest Pulmonary edema Pneumonia

9 9

.02

4 (27)

11 (73)

Surgical area Nasal

3

0

3

0

3 (60)

2 (4)

2

2

0

0

Palatopharyngeal

19 (58)

14 (42)

.60

Tongue base Combination

2 (50)

2 (5)

2

2

0

0

23 (43)

30 (57)

Surgery time, median (IQR), min AHI, median (IQR)

85 (72-91)

120 (54-166)

.01

3 4

0 1

3 3

0 0 0

Aspiration

31.6 (28.5-36.5)

31.8 (27.3-58.6) .66

Total

41 (43)

23 (66)

18 (72)

Polysomnography finding, mean (SD) Lowest oxygen desaturation, % 79 (2)

Cardiovascular related a Arrhythmia

68 (2)

.001

6 2

6 1

0 0

0 1

Longest apnea duration, s

39 (3)

51 (3)

.002

Persistent hypertension

Postoperative ward General ward

surgery sites. Themain finding is that, among patients under- going upper airway surgery as a treatment for OSA, we did not find an independent association between severity of OSA as determined by the AHI with short-term operative complica- tions. Within the polysomnographic variables, only Lsat and longest apnea duration predict the operative complications. No association was found between the number and levels of concurrent upper airway surgery performed and frequency of operative complications. Limitations It is challenging to study risks of surgical complications inOSA cases because of the wide variations of the definitions used for complications among studies and the low incidence of life- threatening complications, which requires a large sample size to analyze with significance. In addition, previous studies 2,8 that used clinical symptoms of OSA as their selection criteria without performing polysomnography for standard diagno- sismay have included other forms of sleep-disordered breath- ing (SDB), such as upper airway resistance syndrome, which 1 (13) Abbreviations: BiPAP, bilevel positive airway pressure; CPAP, continuous positive airway pressure. a Some cases had more than 1 type of complication at 1 time. Total 8 (8) 7 (20) 0

34 (63) 13 (32)

20 (37) 28 (68)

.003

ICU

Postoperative analgesia Opioids

17 (45) 11 (79)

21 (55)

NSAIDs

3 (21)

.10

Paracetamol

0

1 (100)

COX-2 inhibitor

19 (45)

23 (55)

Hospital stay, median (IQR), d

3 (2-5)

4 (3-8)

.003

may affect the true interpretation of the results. The criteria for diagnosis of upper airway resistance syndrome is still controversial, 2,8 and increasingly more physicians recognize upper airway resistance syndrome as a clinical syndrome that has differential features from OSA. 21 With these limitations inmind, it is not surprising that past studies 7-12 designed to assess OSA as a risk factor for opera- a Data are presented as number/total 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. Abbreviations: AHI, apnea-hypopnea index; BMI, body mass index; COX-2, cyclooxygenase 2; ICU, intensive care unit; IQR, interquartile range; NSAID, nonsteroidal anti-inflammatory drug.

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

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