Admission may not be needed following sleep apnea surgery

1. Adverse respiratory events following corrective surgery for sleep apnea are much lower than previously noted.

2. Respiratory complications that do occur are likely to arise in the first few hours following surgery and are predominantly simple oxygen desaturations.

Evidence Rating Level: 2 (Good)      

Study Rundown: Literature suggests that the incidence of adverse respiratory events following obstructive sleep apnea (OSA) surgery is quite high (>10%). As a result, most perioperative management guidelines recommend postoperative continuous overnight oxygen monitoring. In this study, the authors examined the respiratory complication rate following OSA surgery to determine whether patients benefited from postoperative monitoring. They found that there were no OSA-specific complications in patients that were discharged on the same day or required overnight admission. In addition, they found that none of the variables (e.g. age, AHI, body mass index, oxygen saturation) predicted complications or need for admission. An important strength of this study is its prospective study design. However, the study was limited by its small sample size and exclusion of patients with known cardiovascular comorbid disease. Although this study is not the first to demonstrate a low incidence of respiratory complications in patients following OSA surgery, it further draws into question the reflexive need for hospital admission in this patient group.

Click to read the study in Laryngoscope

Relevant Reading: Safety of multilevel surgery in obstructive sleep apnea: a review of 487 cases (JAMA-Otolaryngology)

In-Depth [prospective cohort]: This was a prospective study involving 50 patients from a single institution. All included patients had sleep study-proven OSA and underwent multilevel sleep apnea surgery. Based on risk stratification, patients were divided into 2 groups following surgery: safe for same-day discharge and requiring admission for postoperative continuous overnight monitoring. In this study, 39 (78%) patients met criteria for same-day discharge while 11 (22%) patients required admission. For the patients who were discharged home on the same day, there was a 0% readmission or OSA-specific complication rate; the postoperative phone interviews confirmed that there were no respiratory concerns. The 11 patients who were admitted overnight desaturated below 90% in the first few hours following surgery but no OSA-specific complications occurred during their overnight stay.

Image: PD

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