Is postoperative intensive care monitoring necessary after uvulopalatopharyngoplasty?
We conducted a retrospective review of 347 consecutive patients who underwent surgical treatment for obstructive sleep apnea syndrome. We analyzed perioperative data to identify the nature and rate of complications in an attempt to determine whether intensive care unit monitoring is needed after uvulopalatopharyngoplasty (UPPP) and associated procedures including septoplasty, tonsillectomy, turbinate reduction, geniohyoid advancement, and tracheostomy. In the 347 cases, 14 complications occurred (4%), including 5 involving the airway, 5 postoperative hemorrhages, and 4 complications classed as "other," including dehiscence of a tracheostomy flap, abdominal ileus, urine retention, and increased creatinine concentration. We found no difference between preoperative lowest oxygen saturation and oxygen-saturation readings in the postoperative period and no correlation between complication rate and apnea severity. An association was detected between multiple simultaneous procedures and the development of complications: 50% of the patients in whom complications developed had undergone nasal procedures along with UPPP, compared with only 15% of the patients without complications. Except for one patient, all complications that occurred on the surgical ward were treated without transfer to the intensive care unit. Although surgery on the upper airway must be performed with caution in patients with sleep apnea, our findings suggest that UPPP is a safe procedure and that postoperative monitoring in an intensive care setting is not necessary for most patients.
Atlanta Ear Nose and Throat Associates, Georgia 30342, USA.
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Mickelson
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Hakim
D002680:Chin / Q000601:surgery; D003404:Creatinine / Q000652:urine; D003422:Critical Care; D005260:Female; D006801:Humans; D006928:Hyoid Bone / Q000601:surgery; D007415:Intestinal Obstruction / Q000209:etiology; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D009300:Nasal Septum / Q000601:surgery; D020380:Needs Assessment; D010100:Oxygen / Q000097:blood; D010160:Palate, Soft / Q000601:surgery*; D010614:Pharynx / Q000601:surgery*; D011182:Postoperative Care; D011183:Postoperative Complications; D019106:Postoperative Hemorrhage / Q000209:etiology; D012120:Respiration Disorders / Q000209:etiology; D012189:Retrospective Studies; D012891:Sleep Apnea Syndromes / Q000503:physiopathology / Q000601:surgery*; D013529:Surgical Wound Dehiscence / Q000209:etiology; D014068:Tonsillectomy / Q000009:adverse effects; D014139:Tracheostomy / Q000009:adverse effects; D014420:Turbinates / Q000601:surgery; D016055:Urinary Retention / Q000209:etiology; D014609:Uvula / Q000601:surgery*
D003404:Creatinine; D010100:Oxygen