Safety of Outpatient Sleep Surgery: A Retrospective Review

Introduction: Surgical treatments for obstructive sleep apnea (OSA) are alternatives for patients intolerant of CPAP. These procedures, including tonsillectomy, uvulopalatopharyngoplasty (UPPP), nasal surgery (septoplasty, turbinate reduction), and upper airway stimulator (UAS) are considered safe and are well tolerated. We hypothesized that severity of OSA, co-morbidities, and distance travelled for surgery would be the primary predictors of hospital admission or adverse outcomes.

Methods: This is a retrospective review. Demographic data including age, gender, race, BMI, insurance status, socioeconomic status (state and national Area Deprivation Index), and distance travelled for surgery was collected, as well as co-morbidities, AHI, and type of surgery performed. Outcome variables included postoperative admission, remaining intubated, ED presentation or readmission within 7 days of surgery. Logistic regression (LR) models were developed for analysis.

Results: 374 patients were included who underwent sleep surgery at Thomas Jefferson University between 2017 and 2022. Average age was 54 years (95% CI 40-68). 260 patients (69.5%) were male, 309 (82.3%) were Caucasian, and average distance travelled was 22 miles (0-44). Average AHI was 30 (11-50). 157 UAS were performed, 65 tonsillectomies, 109 UPPPs, and 138 nasal procedures. 0 patients remained intubated postoperatively. There were 9 (2%) planned admissions, and 29 (8%) total admissions post-op. 17 patients (4.5%) presented to the ED within 7 days, and 12 (3.2%) were readmitted. LR found significant predictors of planned admission included UPPP, AHI, distance travelled, and co-morbidities. Predictors of ED presentation included insurance status, ADI, and AHI. Presence of HTN, CHF and insurance status were predictors of readmission.

Conclusions: Outpatient sleep surgery is generally safe. Close postoperative monitoring is necessary and overnight observation should be considered in those with very severe OSA and/or significant co-morbidities. The distance a patient travels to receive care should also be considered for overnight admission.