Tuesday, September 23, 2014
About Our Faculty: Dr. John Fuller
Laryngoscope. 2014 Sep 15. doi: 10.1002/lary.24930. [Epub ahead of print]
Rotenberg B, Theriault J, Cheng H, Fuller J.
Evidence is lacking to guide whether patients with obstructive sleep apnea (OSA) require mandatory postoperative monitoring when undergoing multilevel sleep surgery. The purpose of this study was to examine the respiratory complication rate following OSA surgery and identify which patients benefit from monitoring after surgery.
A prospective study was conducted.
Fifty patients (age 45.4 ± 12.4; male 39, female 11), with sleep study-proven OSA (apnoea/hypopnoea index [AHI] 24.3 ± 22.2) underwent multilevel sleep surgery. All patients had the St. Joseph's OSA risk score calculated preoperatively and then again within the postanesthesia care unit (PACU). The patients were then stratified into two categories: safe for same-day discharge and requiring admission for overnight O2 saturation monitoring. Groups were compared across age, sex, AHI, body mass index, mean O2 saturation, minimum O2 saturation, length of time in PACU, narcotic use, smoking, surgery type, and other comorbidities. The St. Joseph's OSA Risk Tool was applied.
Seventy-eight percent of patients met criteria for same-day discharge, and 22% required admission. For the discharged patients, we had a 0.0% readmission or complication rate for OSA-specific reasons. For the admitted patients, we had no OSA-specific complications while admitted to hospital. No variables consistently predicted complications or need for admission.
The incidence of respiratory events requiring intervention following multilevel sleep surgery is very low. Most patients with OSA undergoing surgery can be safely discharged home without any subsequent respiratory complications. In addition, those patients admitted for monitoring after surgery do not benefit from their admission.
© 2014 The American Laryngological, Rhinological and Otological Society, Inc.
See the Article in PubMed