Department of Otorhinolaryngology-Head and Neck Surgery, International Islamic University Malaysia, Jalan Hospital, Kuantan, Pahang, Malaysia.
Department of Community Medicine, International Islamic University Malaysia, Jalan Hospital, Kuantan, Pahang, Malaysia.
JAMA Otolaryngol Head Neck Surg. 2017 Mar 1;143(3):239-246. doi: 10.1001/jamaoto.2016.3268.
In patients with obstructive sleep apnea (OSA), operative risks depend on the severity of the underlying OSA and the invasiveness of the surgical procedure.
To investigate the nature of the associations between the severity of OSA and the number and anatomical sites of upper airway operations with operative complications.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective study included adult patients diagnosed with OSA (apnea-hypopnea index [AHI], >5) who underwent upper airway surgery at a single tertiary referral hospital between October 1, 2008, and October 1, 2015.
All patients underwent single or combination surgery on the nose, palatopharyngeal (tonsils, adenoids, and soft palate), and tongue base as a treatment of OSA.
Pulmonary, surgical, and cardiovascular complications within the first 30 postoperative days were analyzed according to OSA severity and types of upper airway surgery. Logistic regression was used to assess the multivariable association of OSA, age, sex, body mass index, medical comorbidities, and types of upper airway surgery with short-term operative complications.
The study included 95 patients (87 males [91.6%]; 83 were Malay [87.4%]; mean [SD] age, 37.7 [1.6] years) with complete data and follow-up who underwent upper airway surgery to treat OSA. Patients with more severe OSA had greater body mass index (Cohen d, 0.27; 95% CI, -0.28 to 0.82), longer surgical time (Cohen d, 1.57; 95% CI, 0.95-2.15), and older age (Cohen d, 3.06; 95% CI, 2.29-3.77). At least 1 operative complication occurred in 48 of 95 patients (51%). In a multivariable model, the overall complication rate was increased with age and body mass index. Complication rates were not associated with AHI severity, type of procedure performed, and whether the surgery was single or combination surgery. Lowest oxygen desaturation (odds ratio, 1.03; 95% CI, 0.96-1.45; P = .04) and longest apnea duration (odds ratio, 1.03; 95% CI, 0.99-1.08; P = .02) were polysomnographic variables that predict the short-term operative complications.
In patients with OSA undergoing upper airway surgery, the severity of OSA as assessed by AHI, and the sites and numbers of concurrent operations performed were not associated with the rate of short-term operative complications.
在阻塞性睡眠呼吸暂停（OSA）患者中，手术风险取决于潜在 OSA 的严重程度和手术的侵袭性。
研究 OSA 严重程度与上气道手术的数量和解剖部位与手术并发症之间的关系。
设计、地点和参与者：这项回顾性研究纳入了 2008 年 10 月 1 日至 2015 年 10 月 1 日期间在一家三级转诊医院接受上气道手术的诊断为 OSA（呼吸暂停-低通气指数[AHI]，>5）的成年患者。
所有患者均接受单一或联合鼻部、腭咽（扁桃体、腺样体和软腭）和舌基手术治疗 OSA。
根据 OSA 严重程度和上气道手术类型，分析术后 30 天内的肺部、手术和心血管并发症。使用 logistic 回归评估 OSA、年龄、性别、体重指数、合并症和上气道手术类型与短期手术并发症的多变量关联。
这项研究纳入了 95 名（87 名男性[91.6%]；83 名马来人[87.4%]；平均[标准差]年龄，37.7[1.6]岁）具有完整数据和随访的患者，他们接受了上气道手术以治疗 OSA。OSA 更严重的患者体重指数更高（Cohen d，0.27；95%CI，-0.28 至 0.82），手术时间更长（Cohen d，1.57；95%CI，0.95-2.15），年龄更大（Cohen d，3.06；95%CI，2.29-3.77）。95 名患者中有 48 名（51%）至少发生了 1 种手术并发症。在多变量模型中，总体并发症发生率随年龄和体重指数的增加而增加。并发症发生率与 AHI 严重程度、手术类型以及手术是单一手术还是联合手术无关。最低氧饱和度下降（比值比，1.03；95%CI，0.96-1.45；P=0.04）和最长呼吸暂停时间（比值比，1.03；95%CI，0.99-1.08；P=0.02）是预测短期手术并发症的多导睡眠图变量。
在接受上气道手术的 OSA 患者中，AHI 评估的 OSA 严重程度以及同时进行的手术部位和数量与短期手术并发症发生率无关。
