Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine, New York, New York, U.S.A.
Laryngoscope. 2022 Mar;132(3):706-710. doi: 10.1002/lary.29875. Epub 2021 Sep 24.
OBJECTIVES/HYPOTHESIS: Hypoglossal nerve stimulator (HGNS) implantation is highly effective in treating obstructive sleep apnea (OSA) in select patient populations that are intolerant of continuous positive airway pressure. Implantation surgery is traditionally performed in hospital outpatient departments (HOPD) due to concern about anesthetic effects and airway manipulation in an OSA population. In this study, we examined complications and efficiency of HGNS implantation in an ambulatory surgery center (ASC) versus HOPD.
Retrospective cohort study.
Patients with HGNS implantation performed between May 2015-January 2021 at our HOPD or ACS were included. Patient-related characteristics, surgical times, and postoperative complications were obtained via chart review. Reimbursement data on a national level for Medicare patients were calculated based on publicly available data from the Center for Medicare Services. Patient characteristics, surgical times, and complications were summarized as medians with interquartile ranges (IQRs) and proportions in each surgical setting group as appropriate. These were compared between surgical setting groups via Wilcoxon rank-sum testing and χ testing.
A total of 122 patients were included. Patients in the HOPD group had significantly higher median apnea-hypopnea index (AHI) (42.0 [IQR 27.9-51.0]) compared to the ASC group (31.0 [IQR 21.0-44.2], P = .005). The intervals between in-room and case start, case finish and out-of-room, and time in the postoperative area were significantly shorter in the ASC group compared to the HOPD group. Reimbursement on a national level was estimated at 18% lower for patients with surgery performed at the ASC. There was no significant difference in postoperative complications.
HGNS implantation in an ASC is safe and more efficient than in a HOPD, and may also be more cost-effective.
3 Laryngoscope, 132:706-710, 2022.
目的/假设：舌下神经刺激器（HGNS）植入术在不能耐受持续气道正压通气的特定不耐受患者人群中治疗阻塞性睡眠呼吸暂停（OSA）非常有效。由于担心 OSA 人群中的麻醉效果和气道操作，植入手术传统上在医院门诊部门（HOPD）进行。在这项研究中，我们研究了在门诊手术中心（ASC）与 HOPD 进行 HGNS 植入的并发症和效率。
回顾性队列研究。
纳入 2015 年 5 月至 2021 年 1 月期间在我们的 HOPD 或 ASC 进行 HGNS 植入的患者。通过病历回顾获得患者相关特征、手术时间和术后并发症。根据医疗保险服务中心提供的公开数据，计算了 Medicare 患者在全国范围内的报销数据。患者特征、手术时间和并发症以中位数（四分位距 IQR）表示，并按适当的手术环境组进行总结。通过 Wilcoxon 秩和检验和 χ 检验比较手术环境组之间的差异。
共纳入 122 例患者。HOPD 组患者的中位呼吸暂停低通气指数（AHI）（42.0[IQR 27.9-51.0]）显著高于 ASC 组（31.0[IQR 21.0-44.2]，P=0.005）。ASC 组的入室与开始手术、完成手术与离开手术间、进入术后区与离开术后区的间隔时间明显短于 HOPD 组。ASC 组手术患者的全国报销水平估计低 18%。术后并发症无显著差异。
与 HOPD 相比，在 ASC 中进行 HGNS 植入术安全且更高效，且可能更具成本效益。
3 级喉镜，132：706-710，2022 年。
