Safety of Outpatient Surgery for Obstructive Sleep Apnea

Abstract

Objective: This retrospective cohort study of adult Medicaid obstructive sleep apnea (OSA) patients undergoing head and neck airway surgery sought to determine their safety experience. Physicians will: 1) Gain insight into inpatient and ambulatory management considerations for OSA. 2) Understand how administrative data sets can be used to answer quality questions.

Method: Four hundred fifty-two patients (404 ambulatory, 48 inpatient) receiving head and neck airway surgery from 01/01/2009 to 06/30/2011. Four safety indicators were reported from administrative data for 30 days: ER visit, inpatient admission, observation day, and 3 or more PCP visits. MI, DVT, stroke, PE, tracheostomy, or transfusions were noted.

Results: OSA subjects (3.29 ambulatory, 3.78 inpatient) had greater risk scores (sicker) than plan members (P < .05). The majority (89%) of the surgeries were ambulatory. No difference in safety indicator rates was identified between ambulatory and inpatient groups (P > .61). ER visit was the most common adverse outcome (19% overall). Median time to first ER visit was significantly longer among ambulatory patients (7 days) than inpatients (3 days) (P = .03). The observed catastrophic complication rate among ambulatory patients was zero (95% CI: 0.0%-1.1%). Administrative data sets can be used to provide insight into practice safety questions.

Conclusion: Contrary to guidelines, OSA patients are undergoing ambulatory head and neck airway surgery. Administrative data sets can be used to provide insight into practice safety questions. Further study is warranted of ambulatory surgery management of adult sleep apnea patients.