Friedman Jacob J, Salapatas Anna M, Bonzelaar Lauren B, Hwang Michelle S, Friedman Michael
1 University of Illinois College of Medicine, Chicago, Illinois, USA.
2 ChicagoENT, Advanced Center for Specialty Care, Chicago, Illinois, USA.
Otolaryngol Head Neck Surg. 2017 Jul;157(1):123-127. doi: 10.1177/0194599817706500. Epub 2017 May 16.
Objective Whereas uvulopalatopharyngoplasty (UPPP) was the standard surgical procedure for obstructive sleep apnea prior to 2007, multilevel surgery has become the standard since that time. This study compares morbidity and mortality rates of the stand-alone UPPP with those of multilevel sleep surgery that includes UPPP. Methods Patients undergoing UPPP between 2007 and 2014 were identified in the American College of Surgeons National Surgical Quality Improvement Program database. UPPP was defined by Current Procedural Terminology codes 42145 and 42950. Primary outcomes were incidence of morbidity and mortality. Rates were compared between a control group with UPPP only and a group with multilevel surgery. Results A total of 2674 cases were analyzed. The incidence of complications in the UPPP-only group was 1.6% (0.09% fatal); in the multilevel surgery group, 4.63% (0.19% fatal). The difference in overall and nonfatal complications is statistically significant ( P < .01); however, values for fatal complications are too low for comparison. There is a statistically significant ( P < .01) positive correlation ( R = 0.92) between year of operation and rate of complications, with increased incidence of complications in more recent years. Discussion Complication rates for multilevel sleep surgery are higher than those of stand-alone UPPP, and overall complication rates have been increasing in recent years. As UPPP supplemented with multilevel surgery is now the standard surgical treatment for most cases of obstructive sleep apnea-hypopnea syndrome, historical complication rates based predominantly on patients undergoing UPPP only underestimate complication rates of modern sleep surgery. Implications for Practice It is reasonable to inform patients that multilevel procedures bring an increased risk of complications, and patient selection should be guided accordingly.
在2007年之前，悬雍垂腭咽成形术（UPPP）是治疗阻塞性睡眠呼吸暂停的标准外科手术，自那时起，多平面手术已成为标准术式。本研究比较单纯UPPP与包括UPPP在内的多平面睡眠手术的发病率和死亡率。方法：在美国外科医师学会国家外科质量改进计划数据库中识别2007年至2014年期间接受UPPP的患者。UPPP由当前手术操作术语编码42145和42950定义。主要结局是发病率和死亡率。比较仅接受UPPP的对照组与接受多平面手术的组之间的发生率。结果：共分析2674例病例。单纯UPPP组的并发症发生率为1.6%（0.09%为致命性）；多平面手术组为4.63%（0.19%为致命性）。总体和非致命性并发症的差异具有统计学意义（P <.01）；然而，致命性并发症的值过低无法进行比较。手术年份与并发症发生率之间存在统计学意义（P <.01）的正相关（R = 0.92），近年来并发症发生率增加。讨论：多平面睡眠手术的并发症发生率高于单纯UPPP，且近年来总体并发症发生率一直在增加。由于目前UPPP联合多平面手术是大多数阻塞性睡眠呼吸暂停低通气综合征病例的标准外科治疗方法，主要基于仅接受UPPP患者的历史并发症发生率低估了现代睡眠手术的并发症发生率。对实践的启示：告知患者多平面手术会增加并发症风险是合理的，应据此指导患者选择。
