Large Tertiary System Research Articles

Problem: Obstructive sleep apnea syndrome (OSAS) is a common disease with significant morbidity. Uvulopalatopharyngoplasty (UPPP) is the primary surgical therapy for OSAS. The goal of this study was to compare the frequency of UPPP in white and African-American patients in VHA hospitals and a large tertiary private hospital system. Methods: This retrospective cohort study utilizes the VHA National Patient Care Database and databases from a large hospital system. Patients were identified with an index diagnosis of OSAS in FY1999, with subsequent UPPP from FY1999 to FY2002. Results: In FY1999, 20,402 VHA patients satisfied the definition of index cases of OSAS in FY1999. Of these, 15,100 (74%) could be identified by race, 80% were white, and 15% were African American. Between FY 1999 and FY 2002, 413 underwent a UPPP, 82% white, and 12.8% African American. The tertiary system had 1,145 OSAS diagnoses in FY1999, 86% white, and 11% African American. Sixty patients underwent UPPP, 83% white, and 12% African American. Time to surgery did not differ by race for VHA patients. Adjustment for comorbidities did not alter the results. Conclusion: Unlike many other surgical procedures, there does not appear to be significant racial disparity in UPPP in the VHA or in a large tertiary system. However, patients treated in the tertiary system are almost twice as likely to undergo UPPP as VHA patients. Significance: Racial disparities in the use of some surgical procedures, but not others, merit further study. The implications of increased use of UPPP in a tertiary hospital system compared to the VHA requires investigation. Support: VA Health Services Research and Development Grant (LIP)-$10,000