Safety of Multilevel Surgery in Obstructive Sleep Apnea A Review of 487 Cases

Objective: To review the safety of multilevel surgery in patients with obstructive sleep apnea (OSA). Design: Retrospective review. Patients: A total of 487 consecutive patients with OSA and 1698 surgical procedures from January 2007 to May 2010. Interventions: Multilevel OSA surgery comprising nasal surgery (endoscopic sinus surgery, septoplasty, and inferior turbinate reduction), palate surgery (traditional uvulopalatopharyngoplasty, expansion sphincter pharyngoplasty and anterior palatoplasty), and tongue surgery (hyoid suspension, radiofrequency tongue base, and tongue suspension suture). Main Outcome Measures: Surgical complications. Results: The overall complication rate was 7.1%, with 1 patient having an upper airway obstruction. Complications were as follows: (1) 6 patients had postoperative oxygen desaturation within 3 hours after extubation (these patients had severe OSA [apnea-hypopnea index >60 and lowest oxygen saturation level <80%]), (2) 15 patients had persistent hypertension (these patients had a history of hypertension), (3) 15 patients had secondary hemorrhage (7-12 days postoperatively), (4) there were 2 cases of negative pressure pulmonary edema, (5) 9 patients had tongue edema (following tongue surgery), and (6) 1 patient had upper airway obstruction requiring reintubation. Patients who had undergone tongue surgery were admitted routinely to the high-dependency unit (step-down care from the intensive care unit) overnight. Conclusions: Routine postoperative admission to the intensive care unit for all patients with OSA is unnecessary. These patients should be closely monitored in the post-anesthesia care unit area after surgery, and based on the outcome of this period, they can be observed overnight in either the high-dependency unit or the general ward.