Ambulatory Surgical Management of Obstructive Sleep Apnea: Is It Safe?

Abstract

Objectives: Determine the safety of ambulatory oropharyngeal surgery in adults with obstructive sleep apnea. Methods: Retrospective cohort study. Relevant data were collected from patients aged 18+ years with obstructive sleep apnea (OSA) receiving head and neck airway surgery between September 1, 2005, and September 15, 2012. Results: Out of 315 patients with complete data, 243 (77.14%) were managed as inpatients and 72 (22.86%) in an ambulatory manner. The mean Apnea/Hypopnea Index (AHI) for the inpatient and ambulatory groups were 35.99 and 18.43, respectively ( P < .00). The mean body mass index (BMI) for the inpatient and ambulatory groups was 34.12 and 30.79, respectively ( P < .0002). When calculating the incident risk ratio of changes in AHI or BMI, AHI exhibited a significantly increased contribution. There were no complications in the ambulatory cohort. Conclusions: When evaluating body habitus and polysomnographic data, OSA patients who underwent oropharyngeal procedures and were discharged on the same day were significantly different than those who were admitted to the hospital. It appears from this data that patients with mild-moderate sleep apnea, even for patients with mild obesity, are safe to have these procedures performed in an ambulatory setting. This data could potentially assist practitioners in determining which procedures could be safely planned for an ambulatory setting and therefore decrease health care expenditures and patient inconvenience while maintaining patient safety. Future studies investigating what, if any, inpatient interventions were provided for those patients that were admitted to the hospital could potentially further expand the group of patient who could be safely managed in an ambulatory setting.