Cillo Joseph E, Dattilo David J
Assistant Professor and Program Director, Division of Oral and Maxillofacial Surgery, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, PA.
Division Director, Division of Oral and Maxillofacial Surgery, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, PA.
J Oral Maxillofac Surg. 2015 Jan;73(1):123-8. doi: 10.1016/j.joms.2014.07.023. Epub 2014 Jul 30.
The purpose of this study was to determine the frequency and relative risk (RR) of early postoperative major medical complications after surgery for the management of obstructive sleep apnea.
This was a retrospective cohort analysis of patients who had undergone surgery for the treatment of polysomnogram-confirmed obstructive sleep apnea at 2 hospitals in Pittsburgh, PA, between 1992 and 2013. Early postoperative major medical complications were defined as either a life-threatening complication requiring intensive care unit intervention or death within the immediate hospital course. Standard demographic data, apnea-hypopnea index, Epworth Sleepiness Score, minimum nocturnal oxygen saturation, and body mass index were collected. The 2-tailed independent t test, Fisher exact test, and RR with 95% confidence interval were used.
A total of 267 consecutive patients who underwent surgery for obstructive sleep apnea and met the inclusion criteria were included in this study. A total of 6 patients (6 of 267, 2.2%) had early major medical postoperative complications. When stratified by surgical group (intrapharyngeal vs extrapharyngeal), there were 162 intrapharyngeal patients with 2 complications (1.2%) and 105 extrapharyngeal patients with 4 complications (3.8%). We found no statistically significant difference in frequency (2 of 162 intrapharyngeal patients [1.2%] vs 4 of 105 extrapharyngeal patients [3.8%], P = .17) or RR (3.1; 95% confidence interval, 0.58 to 16.55; P = .1885) between the groups. There were statistically significant differences for mean age, apnea-hypopnea index, Epworth Sleepiness Score, minimum nocturnal oxygen saturation, and body mass index between the surgical groups.
The overall frequency of early major medical postoperative complications in upper airway surgery for obstructive sleep apnea is low, with no statistically significant difference in frequency and RR between intrapharyngeal and extrapharyngeal surgery. There may, however, be a clinically significance difference in RR possibly because of associated differences in risk factors between the groups.
本研究旨在确定阻塞性睡眠呼吸暂停手术治疗后早期术后严重医疗并发症的发生率及相对风险（RR）。
这是一项对1992年至2013年间在宾夕法尼亚州匹兹堡市两家医院接受多导睡眠图确诊的阻塞性睡眠呼吸暂停手术治疗的患者进行的回顾性队列分析。早期术后严重医疗并发症定义为需要重症监护病房干预的危及生命的并发症或在医院近期病程内死亡。收集了标准人口统计学数据、呼吸暂停低通气指数、爱泼华嗜睡量表、夜间最低血氧饱和度和体重指数。采用双尾独立t检验、Fisher精确检验以及95%置信区间的RR。
本研究共纳入267例连续接受阻塞性睡眠呼吸暂停手术且符合纳入标准的患者。共有6例患者（267例中的6例，2.2%）发生早期术后严重医疗并发症。按手术组（咽内手术与咽外手术）分层时，162例咽内手术患者中有2例并发症（1.2%），105例咽外手术患者中有4例并发症（3.8%）。我们发现两组之间在发生率（162例咽内手术患者中的2例[1.2%] vs 105例咽外手术患者中的4例[3.8%]，P = 0.17）或RR（3.1；95%置信区间，0.58至16.55；P = 0.1885）方面无统计学显著差异。手术组之间在平均年龄、呼吸暂停低通气指数、爱泼华嗜睡量表、夜间最低血氧饱和度和体重指数方面存在统计学显著差异。
阻塞性睡眠呼吸暂停上气道手术中早期术后严重医疗并发症的总体发生率较低，咽内手术和咽外手术在发生率和RR方面无统计学显著差异。然而，RR可能存在临床意义上的差异，这可能是由于两组之间危险因素的相关差异所致。
