Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A.
Laryngoscope. 2014 May;124(5):1251-8. doi: 10.1002/lary.24346. Epub 2014 Mar 4.
OBJECTIVES/HYPOTHESIS: Growing evidence supports the use of multilevel surgery to effectively address obstructive sleep apnea (OSA). We sought to characterize changes in the patterns of surgical sleep care over time.
Repeated cross-sectional study.
Discharge data from the US Nationwide Inpatient Sample for 232,470 patients who underwent nasal, palatal, or hypopharyngeal procedures for sleep disordered breathing or OSA from 1993 to 2010 were analyzed using cross-tabulations and multivariate regression modeling.
Inpatient sleep surgical procedures increased from 97,363 performed in 1993-2000 to 135,107 in 2001-2010. Sleep surgery in 2001-2010 was associated with increased hypopharyngeal surgery (relative risk ratio [RRR] = 3.6, 95% confidence interval [CI] = 2.6-4.9, P < .001), tongue radiofrequency/midline glossectomy (RRR = 5.1, 95% CI = 3.4-7.5, P < .001), hyoid suspension (RRR = 6.8, 95% CI = 3.8-12.5, P < .001), nasal surgery (RRR = 1.3, 95% CI = 1.1-1.5, P = 0.002), and multilevel surgery (RRR = 5.6, 95% CI = 3.8-9.4, P < .001) and decreased tracheostomy (RRR = 0.58, 95% CI = 0.49-0.68, P < .001) compared to 1993-2000. Patients undergoing sleep surgery in 2001-2010 were more likely to have an OSA diagnosis (RRR = 1.9, 95% CI = 1.4-2.5, P < .001), obesity (RRR = 1.5, 95% CI = 1.4-1.7, P < .001), and advanced comorbidity (RRR = 2.4, 95% CI = 2.0-2.8, P < .001). In 2001-2010, surgeons (>23 cases/yr) in the top-volume quintile were more likely to perform hypopharyngeal procedures (RRR = 2.4, 95% CI = 1.7-3.4, P < .001,) and to be associated with teaching hospitals (RRR = 1.5, 95% CI = 1.0-2.2, P = 0.034) and less likely to perform tracheostomy (RRR = 0.27, 95% CI = 0.18-0.40, P < .001). However, they represented only 17% of surgeons performing sleep surgery in contrast to surgeons in the bottom-volume quintile, who performed 35% of cases.
These data reflect changing trends in the surgical management of OSA, with meaningful differences in the type of surgical care provided by high-volume surgeons and a significant increase in surgical sleep procedures, particularly nasal and hypopharyngeal surgery.
目的/假设：越来越多的证据支持使用多层次手术来有效治疗阻塞性睡眠呼吸暂停（OSA）。我们旨在描述手术睡眠护理模式随时间的变化特征。
重复横断面研究。
对 1993 年至 2010 年间，在美国全国住院患者样本中，因睡眠呼吸紊乱或 OSA 接受鼻、腭或咽手术的 232,470 例患者的出院数据进行分析，使用交叉表和多变量回归模型。
1993-2000 年进行的住院睡眠手术从 97,363 例增加到 2001-2010 年的 135,107 例。2001-2010 年的睡眠手术与咽手术增加相关（相对风险比[RRR] = 3.6，95%置信区间[CI] = 2.6-4.9，P <.001），舌射频/中线舌切除术（RRR = 5.1，95% CI = 3.4-7.5，P <.001），悬雍垂悬吊术（RRR = 6.8，95% CI = 3.8-12.5，P < .001），鼻手术（RRR = 1.3，95% CI = 1.1-1.5，P = 0.002）和多水平手术（RRR = 5.6，95% CI = 3.8-9.4，P <.001），气管切开术减少（RRR = 0.58，95% CI = 0.49-0.68，P <.001），与 1993-2000 年相比。2001-2010 年接受睡眠手术的患者更有可能被诊断为 OSA（RRR = 1.9，95% CI = 1.4-2.5，P <.001），肥胖（RRR = 1.5，95% CI = 1.4-1.7，P <.001），以及更严重的合并症（RRR = 2.4，95% CI = 2.0-2.8，P <.001）。在 2001-2010 年，排名前五分之一的高容量外科医生更有可能进行咽手术（RRR = 2.4，95% CI = 1.7-3.4，P < .001），并与教学医院相关（RRR = 1.5，95% CI = 1.0-2.2，P = 0.034），并且不太可能进行气管切开术（RRR = 0.27，95% CI = 0.18-0.40，P <.001）。然而，他们仅占进行睡眠手术的外科医生的 17%，而排名最低的五分之一的外科医生则进行了 35%的手术。
这些数据反映了 OSA 手术治疗方式的变化趋势，高容量外科医生提供的手术护理类型存在显著差异，以及鼻和咽手术的显著增加。
