[Obstructive sleep apnea hypopnea syndrome: surgical complications and strategy for avoidance].
OBJECTIVE
To analyze the surgical complications in patients with obstructive sleep apnea hypopnea syndrome (OSAHS) and discuss the risk factors and preliminary strategies for prevention of complications.


METHODS
From September 1998 to March 2007, 653 OSAHS patients confirmed by polysomnography were treated by different surgical approaches according to their obstructive sites, which included uvulopalatopharyngoplasty (UPPP) in 586 cases, nasal surgery in 104 cases/times, hyoid suspension surgery in 53 cases/times, respectively or at the same time. Local anesthesia was used in 294 cases and general anesthesia in 359 cases. Two hundreds and seventeen cases were treated by continuous positive airway pressure (CPAP) 3 to 7 days pre-operation and 2 to 3 days post-operation.


RESULTS
Perioperative complications were found in 57 OSAHS cases (93 times), the incidence of peri-operative complications was 8.7% (57/653), including respiratory problems in 19 cases/times and 1 death occurred during inducing stage in general anesthesia. Profuse bleeding was encountered in 9 cases/times during operation and primary and secondary bleeding in 27 cases/times, cardiopathy and hypertension crisis in 31 cases/times and cerebral stroke and hemiplegia in 1 case, reactive somnolence in 3 cases/times and reactive hyperglycemia in 3 cases/times. Data were analyzed by the multivariate logistic regression model. The results showed that the complications were significantly reduced after CPAP treatment during peri-operative stage and increased accompanied with patients' hypertension, choice of general anesthesia, BMI and AHI. All patients were followed-up more than 1 year. After UPPP, 23.9% cases (140/586) had sensation of foreign body in pharynx and alleviated in 6 to 12 months. Scar tissues in oropharynx in 7 cases, nasopharyngeal stenosis in 1 case, atrophy rhinitides and atrophy pharyngitis in 3 cases, nasopharyngeal un-closure and long-term nasopharyngeal reflex in 3 cases. Conclusions Peri-operative complications are more common in obese and severe OSAHS patients, especially when they accompanied with hypertension. The corresponding strategies should be taken to reduce complications in OSAHS surgery, which include controlling the hypertension effectively, performing CPAP treatment actively, cooperating with interdisciplinary doctors, monitoring closely after operation. It is important to reduce surgical sequelae through improving surgical skills and not enlarging the surgical scale blindly.
Liu
Da-Yu
DY
Department of Otorhinolaryngology, Qilu Hospital of Shandong University, Jinan 250012, China.
Cai
Xiao-Lan
XL
Liu
Hong-Ying
HY
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D013517:Otorhinolaryngologic Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D010159:Palate / Q000601:surgery; D010160:Palate, Soft / Q000601:surgery; D010614:Pharynx / Q000601:surgery; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control*; D020181:Sleep Apnea, Obstructive / Q000601:surgery*; D014609:Uvula / Q000601:surgery; D055815:Young Adult