Baker Andrew B, Xiao Christopher C, O'Connell Brendan P, Cline Jay M, Gillespie M Boyd
Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA.
Otolaryngol Head Neck Surg. 2016 Dec;155(6):1053-1058. doi: 10.1177/0194599816663180. Epub 2016 Aug 23.
(1) Determine the rate of postoperative complications, reoperation, readmission, and death after uvulopalatopharyngoplasty (UPPP) for sleep apnea through multi-institutional clinical data. (2) Compare outcomes of UPPP between multilevel and single-level procedures for the treatment of sleep apnea.
Retrospective database analysis.
The American College of Surgeons National Surgical Quality Improvement Program-a nationally validated, prospective, multi-institutional database from 2005 to 2013-was analyzed for patients who underwent UPPP, per corresponding Current Procedural Terminology codes. Patients were categorized into 3 groups: UPPP alone, UPPP + nasal cavity (NC), and UPPP + base of tongue (BOT). Perioperative outcome measures of interest include surgical/medical complications, reoperation, readmission, and death. Comparisons were made among surgical groups through univariate cross-sectional analysis.
A total of 1079 patients underwent UPPP; 413 patients had UPPP + NC; and 200 patients had UPPP + BOT procedures. One death was reported for the entire cohort of patients. Among all 3 groups (UPPP, UPPP + NC, and UPPP + BOT), no differences were noted in the rates of medical complications (P = .445), surgical complications (P = .396), reoperation (P = .332), and readmission (P = .447). However, the length of hospital stay in days was greatest for the UPPP + BOT group (UPPP, 0.81 ± 0.69; UPPP + NC, 0.87 ± 0.90; UPPP + BOT, 1.50 ± 2.70; P < .001).
These national data demonstrate no significant increase in risk when UPPP is performed as a single- or multilevel procedure. When indicated, UPPP with multilevel procedures may be safely performed for treatment of sleep apnea. These data set a benchmark for perioperative risk in UPPP surgery and will prove useful for counseling patients.
（1）通过多机构临床数据确定悬雍垂腭咽成形术（UPPP）治疗睡眠呼吸暂停后的术后并发症、再次手术、再次入院及死亡发生率。（2）比较用于治疗睡眠呼吸暂停的多平面与单平面UPPP手术的疗效。
回顾性数据库分析。
根据相应的现行手术操作术语编码，对美国外科医师学会国家外科质量改进计划（一个2005年至2013年全国范围内验证的前瞻性多机构数据库）中接受UPPP手术的患者进行分析。患者分为3组：单纯UPPP组、UPPP +鼻腔（NC）组和UPPP +舌根（BOT）组。感兴趣的围手术期结局指标包括手术/医疗并发症、再次手术、再次入院及死亡。通过单变量横断面分析对手术组进行比较。
共有1079例患者接受了UPPP手术；413例患者接受了UPPP + NC手术；200例患者接受了UPPP + BOT手术。整个患者队列报告了1例死亡。在所有3组（UPPP、UPPP + NC和UPPP + BOT）中，医疗并发症发生率（P = 0.445）、手术并发症发生率（P = 0.396）、再次手术率（P = 0.332）和再次入院率（P = 0.447）均无差异。然而，UPPP + BOT组的住院天数最长（UPPP组，0.81±0.69；UPPP + NC组，0.87±0.90；UPPP + BOT组，1.50±2.70；P < 0.001）。
这些全国性数据表明，UPPP作为单平面或多平面手术进行时，风险没有显著增加。如有指征，多平面UPPP手术可安全地用于治疗睡眠呼吸暂停。这些数据为UPPP手术的围手术期风险设定了基准，将有助于为患者提供咨询。
