Overnight Hospital Stay Is Not Always Necessary after Uvulopalatopharyngoplasty

Spiegel, Jeffrey H.; Raval, Tejas

doi:10.1097/01.mlg.0000150703.36075.9c

Cited by 41 publications

(56 citation statements)

References 11 publications

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“…The binomial test was used to determine if any NIC category had incidences that were different from a theoretical referent proportion of 0.1 (i.e., a 10% incidence of any NIC). It was decided that 0.1 would be used as this is near the upper end of the range of incidence of adverse respiratory events reported in the literature following surgical treatments of OSA (ranging from 4%–11%)2–8; in other words, this value would enable us to study a worst case scenario of high incidence of respiratory complications. A sample size calculation was performed using Sample Power version 2.0 (SPSS Inc.); for the binomial test to be significant 95% of the time when results differ from a referent proportion of positive events of 0.1, a sample size of 60 patients would be needed to power the study sufficiently to assess significance.…”

Section: Methodsmentioning

confidence: 99%

Severe anorexia nervosa: Outcomes from a medical stabilization unit

Gaudiani

Sabel

Mascolo

et al. 2010

Intl J Eating Disorders

102

115

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Section: Methodsmentioning

confidence: 99%

Severe anorexia nervosa: Outcomes from a medical stabilization unit

Gaudiani

Sabel

Mascolo

et al. 2010

Intl J Eating Disorders

102

115

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“…A recent study published by Speigel et al10 further suggested that patients undergoing uvulopalatopharyngoplasty (UPPP) may be discharged the day of surgery after 2–3 hours of observation in the post‐anesthesia care unit (PACU).…”

Section: Introductionmentioning

confidence: 99%

A retrospective analysis on patients at high‐risk for obstructive sleep apnea undergoing ear, nose, and throat surgeries

Woodling

Fiorda-Diaz

Otto

et al. 2017

Laryngoscope Investig Oto

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BackgroundObstructive sleep apnea (OSA) may be related to episodes of oxygen de‐saturation, hypercapnia, cardiovascular dysfunction, cor‐pulmonale, and pulmonary hypertension. STOP‐BANG is an acronym for eight specific questions used to assess the likelihood of OSA. If the individual exhibits three or more of these indicators, he/she should be considered to be at high risk for OSA complications. Therefore, the decision of proceeding with inpatient versus outpatient ENT surgery still remains controversial. The primary objective of the study was to identify and correlate desaturation (SPO2 <90%) episodes and risk factors.MethodsWe conducted a single‐center retrospective study between October 1, 2011 and August 31, 2014 in order to identify postoperative complications during the first 24 hours that justify postoperative monitoring and hospital admission. A total of 292 subjects were included for data analysis. Patients were divided into two groups based on the number of OSA risk factors: group A with 3–4 risk factors (n = 166), and group B with ≥5 risk factors (n = 126). The following information was collected: demographics, ASA, preoperative STOP‐BANG score, length of surgery, intraoperative complications, opioid consumption, post anesthesia care unit (PACU) and overall length of stay, supplemental oxygen requirement, oxygen desaturation, and postoperative opioid consumption.ResultsNo statistically significant difference was found when comparing demographic variables between both groups. All STOP‐BANG variables showed statistical significance. PACU and inpatient variables were similar among both groups, with the exception of length of hospital stay (longer stay in group B when compared to group A [p = 0.003]). Desaturation differences between both groups during PACU were statistically significant (p = 0.008). A post‐hoc analysis showed a 0% incidence of overall desaturation in the group with three STOP‐BANG indicators.ConclusionsOur retrospective analysis concluded that patients diagnosed with three STOP‐BANG risk factors did not experience postoperative complications and hospital admission was not justified.Level of Evidence4

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“…No other studies report post-operative death secondary to airway complications. Recent studies show no postoperative mortality [5,7,8,13-15]. This is likely due to increased awareness of risk factors, decreased narcotic use, and perioperative steroid use.…”

Section: Discussionmentioning

confidence: 99%

The incidence of early post-operative complications following uvulopalatopharyngoplasty: Identification of predictive risk factors

Kandasamy

Wright

Fuller

et al. 2013

Journal of Otolaryngology - Head & Neck Surgery

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ObjectiveCharacterize complications following uvulopalatopharyngoplasty (UPPP) for obstructive sleep apnea.Study designRetrospective chart review.Subjects and methodsCharts of patients undergoing UPPP at an academic teaching hospital from 1999 to 2005 were reviewed.Results345 consecutive patients (248 inpatients; 97 outpatients) were studied. The most common post-operative complication in the entire study was oxyhemoglobin desaturation (12.8%). Three patients suffered major complications (airway obstruction, pulmonary edema, arrhythmia). Regarding complications limited to the post-anaesthetic care unit alone, only 8.2% of patients had oxyhemoglobin desaturation after discontinuation of oxygen supplementation. Inpatients requiring supplemental oxygen on the ward had significantly higher mean AHI (37.4 vs. 31.4; p=0.05) and BMI (32.3 kg/m2 vs. 28.9 kg/m2; p=0.004) than those who did not. Those inpatients who were obese (BMI > 30 kg/m2) with an AHI≥22 were associated with an increased risk of requiring oxygen on the ward (odds ratio = 3.48, 95% CI = 1.56 – 7.78).ConclusionThe incidence of post-UPPP complications is much lower than the literature has historically suggested. Selected patients should be able to safely undergo outpatient UPPP. Patients with higher AHI, higher BMI, or multiple comorbidities are at higher risk for postoperative complications and are most appropriate for overnight monitoring.

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Overnight Hospital Stay Is Not Always Necessary after Uvulopalatopharyngoplasty

Cited by 41 publications

References 11 publications

Severe anorexia nervosa: Outcomes from a medical stabilization unit

Severe anorexia nervosa: Outcomes from a medical stabilization unit

A retrospective analysis on patients at high‐risk for obstructive sleep apnea undergoing ear, nose, and throat surgeries

The incidence of early post-operative complications following uvulopalatopharyngoplasty: Identification of predictive risk factors

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