Combined nasal-palatopharyngeal surgery for obstructive sleep apnea: simultaneous or staged?
CONCLUSIONS
Our data indicate that surgical outcomes in a simultaneous surgery group were equivalent to those in a staged surgery group. The simultaneous type of surgery was more cost-effective in terms of total hospitalization expenses.


OBJECTIVE
To compare the outcomes of two types of combined nasal-palatopharyngeal surgery (simultaneous and staged) for the treatment of obstructive sleep apnea (OSA).


METHODS
A total of 85 consecutive patients were enrolled in the study. All patients had OSA and its associated symptoms, were type I according to the Fujita classification, stage 1 or 2 according to the Friedman classification and had nasal obstruction with nasal septal deviation. A modified form of uvulopalatopharyngoplasty (extended uvulopalatal flap surgery) and septomeatoplasty were used to correct upper airway abnormalities. Patients chose to have either a simultaneous (n = 55) or staged (n = 30) type of operation. All patients underwent overnight polysomnography at baseline and < or = 6 months after completion of the operations. Surgical results (reduction of OSA), patient satisfaction, complications and hospitalization expenses were compared between the two groups.


RESULTS
The two groups comprised body mass index- and respiratory disturbance index (RDI)-matched cohorts (p > 0.05). Postoperative decreases in RDI were significant in both groups (p < 0.001), and postoperative RDI was indistinguishable between the two groups (p = 0.77). Incidences of surgical complications, including tonsillar bleeding, nasal septal hematoma, nasal regurgitation and the sensation of a lump in the throat, were similar in the two groups (p = 0.35). The simultaneous surgery group incurred lower total hospitalization expenses than the staged surgery group (p < 0.001).
Li
Hsueh-Yu
HY
Department of Otolaryngology, Chang Gung Memorial Hospital, Taipei, Taiwan. hyli38@yahoo.co.uk
Wang
Pa-Chun
PC
Hsu
Chung-Yao
CY
Lee
Shee-Wei
SW
Chen
Ning-Hung
NH
Liu
Shih-An
SA
D000328:Adult; D005260:Female; D006760:Hospitalization / Q000191:economics; D006801:Humans; D008297:Male; D008875:Middle Aged; D009300:Nasal Septum / Q000601:surgery; D010160:Palate, Soft / Q000601:surgery; D017060:Patient Satisfaction; D010614:Pharynx / Q000601:surgery; D017286:Polysomnography; D011183:Postoperative Complications; D020181:Sleep Apnea, Obstructive / Q000601:surgery*; D013524:Surgical Flaps; D014068:Tonsillectomy; D014609:Uvula / Q000601:surgery