Risk Factors for Serious Complication After Uvulopalatopharyngoplasty

Abstract

To test the hypothesis that comorbidity, performance of concurrent sleep apnea procedures in addition to uvulopalatopharyngoplasty, body mass index, apnea-hypopnea index, and lowest oxygen saturation are risk factors for serious perioperative complications after uvulopalatopharyngoplasty.Design: Prospective cohort and nested case-control studies.Setting: United States Veterans Affairs medical centers.Patients: A prospective cohort of 3130 consecutive adult inpatients who underwent uvulopalatopharyngoplasty from 1991 to 2001 was retrospectively analyzed from the Veterans Affairs National Surgical Quality Improvement Program database to determine the relationship between perioperative complications and both concurrent procedures and medical comorbidity. A nested casecontrol analysis was conducted on 43 cases with complications and 212 controls without complications from the cohort. Controls were matched on age, sex, year of operation, and concurrent surgery; this case-control analysis enabled the study of body mass index, apneahypopnea index, and lowest oxygen saturation, which were not available in the cohort database. Multivariate logistic regression measured associations between risk factors and complications, adjusting or controlling for age, sex, race, smoking status, year of uvulopalatopharyngoplasty, and presence of any concurrent procedure.Main Outcome Measure: Sixteen specific serious perioperative complications, including 30-day mortality. Results:The cohort included 3130 veterans (97% were men aged 50±11 [mean±SD] years). In the cohort study, comorbidity was associated with serious complication: the adjusted risk ratio was 1.96 (95% confidence interval, 1.16-3.18) for each increase in American Society of Anesthesiologists class. Concurrent nonnasal procedures increased the risk of complication compared with no concurrent procedures (adjusted risk ratio, 4.94; 95% confidence interval, 2.34-10.4). In the case-control analyses, the apnea-hypopnea index, body mass index, and medical comorbidity were each associated with serious complication after adjustment for confounding variables, but this study had insufficient power to determine if these risk factors were independent of each other. Concurrent retrolingual procedures demonstrated an independent association with complication after adjustment for confounders. The lowest oxygen saturation was not associated with serious complication.Conclusions: Apnea-hypopnea index, body mass index, and medical comorbidity were each associated with serious complication; however, the low complication rate precluded demonstration of associations independent of each other. Concurrent retrolingual procedures were also associated with serious complication, but the cumulative risk of separate retrolingual procedures is unknown.

Uvulopalatopharyngoplasty in 158 OSAS patients failing non-surgical treatment

“…Our results can be compared with a previous report of more than 3000 patients showing a rate of serious non-fatal complications of 1.5% and a mortality rate of 0.2% [11]. The authors concluded that concomitant tongue or nasal procedures are associated with increased risks of serious complications [12]. Therefore, no types of surgery other than UPPP were performed in the present study.…”

Is overnight monitoring required for adult patients undergoing surgery for obstructive sleep apnea?

“…The respiratory complication rate was 1.1%, which included an array of event types. Of note, this study demonstrated that the majority of postoperative complications requiring intervention emerged within 2 to 4 hours after surgery 5…”

Efficacy of Coblation Endoscopic Lingual Lightening in Multilevel Surgery for Obstructive Sleep Apnea

“…The study was designed for a Friedman stage III population, which has shown suboptimal outcomes after uvulopalatopharyngoplasty. 20,21 Although the results in group 2 herein were better than those of historical uvulopalatopharyngoplasty alone in controls, the addition of CELL to group 1 improved the AHI.…”