30-Day Postoperative Outcomes in Adults with Obstructive Sleep Apnea Undergoing Upper Airway Surgery

Abstract

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.

Incidence and Risk Factors of Postoperative Complications After Rhinoplasty: A Multi-Institutional ACS-NSQIP Analysis

“…Although these variables have been previously identified as risk parameters for other surgical indications, only patient age has already been well described as relevant preoperative variable in rhinoplasty. 3,[10][11][12][13] Of the 45 patients who experienced complications, 60% were male (27/45). In this cohort, the significantly increased complication rate was mainly due to a higher rate of surgical adverse events and more frequent reoperations.…”

“…Multivariable analysis verified male sex and higher ASA scores as risk factors. Although these variables have been previously identified as risk parameters for other surgical indications, only patient age has already been well described as relevant preoperative variable in rhinoplasty 3,10–13 . Of the 45 patients who experienced complications, 60% were male (27/45).…”

An ACS-NSQIP Data Analysis of 30-Day Outcomes Following Surgery for Bell’s Palsy

“…In addition, the standardized data collection results in a lack of potentially relevant and procedure-specific information. The ACS-NSQIP database misses details on short-term (<30 days) complications, including hematoma and seroma, with the postoperative follow-up being limited to 30 days 48,49 . Thus, long-term complications and reoperations (such as brow ptosis correction, management of upper and lower eyelid dysfunction by weight placement and lateral tarsal strip procedure, respectively, tarsorrhaphy, and palpebral spring procedure) were not recorded 1,2,5,50–52 .…”

“…The ACS-NSQIP database misses details on short-term (< 30 days) complications, including hematoma and seroma, with the postoperative followup being limited to 30 days. 48,49 Thus, long-term complications and reoperations (such as brow ptosis correction, management of upper and lower eyelid dysfunction by weight placement and lateral tarsal strip procedure, respectively, tarsorrhaphy, and palpebral spring procedure) were not recorded. 1,2,5,[50][51][52] Similarly, no data were available on long-term corrective procedures of the midface, including nasolabial fold modification, external nasal valve repair, or static facial suspension.…”

The surgical patient of yesterday, today, and tomorrow—a time-trend analysis based on a cohort of 8.7 million surgical patients

“…An age-related and frailty-related decline in health exacerbates surgical vulnerability and predisposes to complications. Frailty is also associated with higher BMI, while overweight and obesity status are independently correlated with worse postoperative outcomes 5 – 11 . Likewise, diabetes mellitus is a well-documented surgical risk factor 12 – 15 .…”