Hypopharyngeal Airway Surgery for Obstructive Sleep Apnea: Morbidity in the Early Postoperative Period

Abstract

Objectives: Determine if hypopharyngeal surgery for obstructive sleep apnea is associated with significant morbidity in the early postoperative period. Methods: Medical records review and retrospective telephone survey of patients who underwent hypopharyngeal surgery for obstructive sleep apnea between November 2012 and September 2013 at a tertiary care facility. Results: Twenty-two patients underwent hypopharyngeal surgery for obstructive sleep apnea. No patient experienced intraoperative complications, postoperative O2 desaturation <90%, prolonged admission for inadequate pain control, pulmonary edema, or airway compromise requiring re-intubation. Postoperative complications included 1 episode of nasal hemorrhage, 1 infection requiring hospitalization, and 1 episode of dehydration treated with IV fluids. Twenty-five percent of patients experienced some degree of postoperative dysphonia, and 87.5% of patients experienced postoperative dysphagia. The average rating for postoperative pharyngeal pain was 3.5 by week 3 and 1.75 by week 4. Most patients described decreased snoring (93.75%), improved feeling of overall health (75%), and increased daytime energy (62.5%). All patients undergoing hypopharyngeal airway surgery were discharged within 23 hours. Conclusions: Hypopharyngeal surgery is a safe and well-tolerated procedure for the treatment of OSA. Our findings suggest that hypopharyngeal surgery may be performed on an outpatient basis.

International Consensus Statement on Obstructive Sleep Apnea

“…However, existing literature on hypopharyngeal surgery lacks large‐volume studies focused on specific procedures within the lower pharynx and results are inconclusive. One study of 22 patients who underwent hypopharyngeal surgery for OSA demonstrated no instances of postoperative desaturation, pulmonary edema, or airway compromise requiring re‐intubation 1565 . MLS may warrant augmented postoperative monitoring, though existing data on management do not provide a sufficient basis for management recommendations.…”

“…One study of 22 patients who underwent hypopharyngeal surgery for OSA demonstrated no instances of postoperative desaturation, pulmonary edema, or airway compromise requiring re-intubation. 1565 MLS may warrant augmented postoperative monitoring, though existing data on management do not provide a sufficient basis for management recommendations.…”

A global consensus regarding the evaluation and management of sleepiness in obstructive sleep apnoea: results of a Delphi process

“…One study of 22 patients who underwent hypopharyngeal surgery for OSA demonstrated no instances of postoperative desaturation, pulmonary edema, or airway compromise requiring re-intubation. 1564 Multilevel surgery may warrant augmented post-operative monitoring, though existing data on management do not provide a sufficient basis for management recommendations.…”

“…Complications are similar to those seen with other surgical treatments of OSA and were only predicted by ASA score and number of procedures performed. Nelson et al 1564…”