Knoedler Samuel, Knoedler Leonard, Baecher Helena, Kauke-Navarro Martin, Obed Doha, Hoch Cosima C, Diehm Yannick F, Vosler Peter S, Harréus Ulrich, Kneser Ulrich, Panayi Adriana C
Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, 93053 Regensburg, Germany.
Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
J Clin Med. 2022 Dec 12;11(24):7371. doi: 10.3390/jcm11247371.
Background: Obstructive sleep apnea (OSA) is a chronic disorder of the upper airway. OSA surgery has oftentimes been researched based on the outcomes of single-institutional facilities. We retrospectively analyzed a multi-institutional national database to investigate the outcomes of OSA surgery and identify risk factors for complications. Methods: We reviewed the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database (2008−2020) to identify patients who underwent OSA surgery. The postoperative outcomes of interest included 30-day surgical and medical complications, reoperation, readmission, and mortality. Additionally, we assessed risk-associated factors for complications, including comorbidities and preoperative blood values. Results: The study population included 4662 patients. Obesity (n = 2909; 63%) and hypertension (n = 1435; 31%) were the most frequent comorbidities. While two (0.04%) deaths were reported within the 30-day postoperative period, the total complication rate was 6.3% (n = 292). Increased BMI (p = 0.01), male sex (p = 0.03), history of diabetes (p = 0.002), hypertension requiring treatment (p = 0.03), inpatient setting (p < 0.0001), and American Society of Anesthesiology (ASA) physical status classification scores ≥ 4 (p < 0.0001) were identified as risk-associated factors for any postoperative complications. Increased alkaline phosphatase (ALP) was identified as a risk-associated factor for the occurrence of any complications (p = 0.02) and medical complications (p = 0.001). Conclusions: OSA surgery outcomes were analyzed at the national level, with complications shown to depend on AP levels, male gender, extreme BMI, and diabetes mellitus. While OSA surgery has demonstrated an overall positive safety profile, the implementation of these novel risk-associated variables into the perioperative workflow may further enhance patient care.
阻塞性睡眠呼吸暂停（OSA）是一种上气道慢性疾病。OSA手术的研究常常基于单一机构的结果。我们回顾性分析了一个多机构的全国数据库，以调查OSA手术的结果并确定并发症的危险因素。方法：我们查阅了美国外科医师学会国家外科质量改进计划（NSQIP）数据库（2008 - 2020年），以确定接受OSA手术的患者。感兴趣的术后结果包括30天手术和医疗并发症、再次手术、再次入院和死亡率。此外，我们评估了并发症的风险相关因素，包括合并症和术前血液值。结果：研究人群包括4662例患者。肥胖（n = 2909；63%）和高血压（n = 1435；31%）是最常见的合并症。虽然术后30天内报告了2例（0.04%）死亡，但总并发症发生率为6.3%（n = 292）。体重指数（BMI）升高（p = 0.01）、男性（p = 0.03）、糖尿病史（p = 0.002）、需要治疗的高血压（p = 0.03）、住院环境（p < 0.0001）以及美国麻醉医师协会（ASA）身体状况分类评分≥4（p < 0.0001）被确定为任何术后并发症的风险相关因素。碱性磷酸酶（ALP）升高被确定为发生任何并发症（p = 0.02）和医疗并发症（p = 0.001）的风险相关因素。结论：在国家层面分析了OSA手术结果，结果显示并发症取决于碱性磷酸酶水平、男性性别、极高的BMI和糖尿病。虽然OSA手术总体上显示出良好的安全性，但将这些新的风险相关变量纳入围手术期工作流程可能会进一步提高患者护理质量。
