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

Abstract

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.

Morbidity and Mortality Rates After Maxillomandibular Advancement for Treatment of Obstructive Sleep Apnea

“…Similarly, complication rates have been described in OSA patients undergoing upper airway procedures such as uvulopalatopharyngoplasty 28,29 . The most common complications detailed in previous studies are atelectasis 22 , pulmonary embolism 22,24 , dysrhythmia 22,24,26,30 , hypoxemia 22,30-32 , hypotension 22,30 , chest pain 22 , myocardial infarction 30,32 , and death 24-26 .…”

Predicting postoperative pulmonary complications

“…Some models have been developed with data from a large mixed surgical population, such as patients undergoing noncardiac surgeries [13,32,34,35,37] or various thoracic [40], cardiac [2], or upper abdominal procedures [14,18,33]. Others focus on specific surgical settings, such as hysterectomy [22], partial hepatectomy [15,24], pancreaticoduodenectomy [23 & ], colorectal surgery [52], esophagectomy [38], bariatric surgery [30], uvulopalatopharyngoplasty [53], spine surgery [26], transoral odontoidectomy and posterior fixation for craniovertebral junction [16], microsurgical clipping of ruptured intracranial aneurysms [17], lower extremity amputation [19], open infrarenal abdominal aortic aneurysm repair [48], lung resection [1,40,54], prostatectomy [25], and radical cystectomy [27]. The reason why it is important to consider the database used to develop a risk model is that some variables included in these models are specific to the procedure, which accounts for a large proportion of postoperative morbidity measures as seen in the analysis of the US Medicare database [10 & ]; thus, the findings may not be generalizable to other populations or clinical settings.…”

“…An adequate preoperative diet can potentially help prevent postoperative infection [4], but the evidence base is insufficient to confirm an effect on PPCs. Obesity per se is not a significant risk factor for PPCs generally speaking and need not affect patient selection for high-risk procedures [4], but it can be a factor in certain surgical settings, such as uvulopalatopharyngoplasty [53] and thoracic surgery [40]. Furthermore, comorbidity associated with obesity does increase PPC risk significantly [39,40,53], and when obesity is severe, the risk situation changes: morbid obesity increases the likelihood of unplanned tracheal intubation [39] and both pneumonia and respiratory failure [30], for example.…”

“…Smoking has been linked to PPCs in many studies [4][5][6][7][38][39][40], and preoperative smoking cessation is Obstructive sleep apnea [53] Procedures with a high risk for ALI/ARDS [36] Hypertension [39] Procedures with a high risk for UEPI [39] Liver disease [39] Emergency surgery [4,7,12,33,35,47,48] Cancer [39] Modifiable patient-related factors Modifiable procedure-related factors Modifiable preoperative testing Low body weight [4,28,39] Prolonged surgery (>3 h) [4,13,24,30,32] Low serum albumin [4] Obesity [39,40,53] General anesthesia [4,7] Anemia [13] Smoking [4,7,30,40 [13] Alcohol consumption [4,7,36,39] Prolonged hospitalization [39] Positive cough test [6,13] Respiratory i...…”

Harmonic Scalpel Assisted Uvalopalatopharyngoplasty

“…In order to control these complications, many devices such as radiofrequency thermotherapy, laser, elctrotome are used in the surgery of UPPP. It is clear that the usage of these devices has reduced the incidence of the implications [5]. In our department, Harmonic scalpel (HS) has been used in UPPP since January 2010.…”