Upper Airway Surgery in Patients with Sleep Apnea

Abstract

Objective: 1) Evaluate the safety of outpatient and overnight observation of sleep apnea surgery patients using new preoperative screening criteria. 2) Compare the cost-effectiveness of outpatient and overnight observational sleep apnea surgery compared to surgical intensive care admission using new preoperative screening criteria.

Method: Retrospective chart review of patients undergoing sleep apnea surgery at the Durham VA between May 2008 and January 2012. A new preoperative protocol was used to triage postoperative care between intensive, routine, or discharge home. Postoperative complications were assessed in each group, and a cost comparison was conducted between groups.

Results: A total of 115 patients underwent sleep surgery between July 2008 and January 2012. Eleven patients were excluded, leaving 104 patients in the final analysis. The average follow-up was 3.6 months. The overall complication rate was 12.5%. Fifty-eight patients were triaged to intensive postoperative care, 21 patients were triaged to routine postoperative care, and 24 patients were not monitored overnight. All of the respiratory and bleeding complications occurred in the immediate postoperative period. All of the complications were adequately handled under the new protocol. The savings over the 3.6 years of this study was $125,275.

Conclusion: Certain patients with sleep apnea can safely be triaged to less than intensive postoperative care. In institutions like the Durham VA, where all sleep apnea patients were historically triaged to intensive care postoperatively, this will lead to significantly lower cost and more efficient use of scarce postoperative resources.