Obstructive sleep apnea surgery practice patterns in the United States: 2000 to 2006.
OBJECTIVE
To determine obstructive sleep apnea (OSA) surgical volume, types, costs, and trends. To explore whether specific patient and hospital characteristics are associated with the performance of isolated palate versus hypopharyngeal surgery and with costs.


METHODS
Cross-sectional study.


METHODS
Inpatient and outpatient medical facilities in the United States.


METHODS
OSA procedures were identified in the Healthcare Cost and Utilization Project Nationwide Inpatient Sample for 2000, 2004, and 2006 and from State Ambulatory Surgery Databases and State Inpatient Databases for 2006 from four representative states (California, New York, North Carolina, and Wisconsin). National combined inpatient and outpatient surgery estimates for 2006 were generated using a combination of databases. Chi-square and regression analysis examined procedure volume and type and inpatient procedure costs.


RESULTS
In 2006, an estimated 35,263 surgeries were performed in inpatient and outpatient settings, including 33,087 palate, 6561 hypopharyngeal, and 1378 maxillomandibular advancement procedures. The odds of undergoing isolated palate surgery were higher for younger (18-39 yrs) and black patients. Outpatient procedures were more common than inpatient procedures. Inpatient surgical volume declined from 2000 to 2006, but it was not possible to evaluate trends in total volumes. In 2006, mean costs were approximately $6000 per admission. For inpatient procedures in 2004 and 2006, costs were higher for hypopharyngeal (vs isolated palate) surgery, in rural hospitals, and for patients who were younger, with greater medical comorbidity, and with primary Medicaid coverage.


CONCLUSIONS
Surgical treatment is performed in 0.2 percent of all adults with OSA annually. Validation of the exploratory findings concerning procedure type and cost requires additional studies, ideally including adjustment for clinical factors.
Kezirian
Eric J
EJ
Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, CA, USA. ekezirian@ohns.ucsf.edu
Maselli
Judy
J
Vittinghoff
Eric
E
Goldberg
Andrew N
AN
Auerbach
Andrew D
AD
D000293:Adolescent; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007013:Hypopharynx / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019647:Oral Surgical Procedures / Q000191:economics / Q000706:statistics & numerical data*; D056948:Orthognathic Surgical Procedures; D013517:Otorhinolaryngologic Surgical Procedures / Q000191:economics / Q000706:statistics & numerical data*; D010159:Palate / Q000601:surgery; D018579:Patient Selection; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D020181:Sleep Apnea, Obstructive / Q000191:economics / Q000453:epidemiology* / Q000601:surgery*; D014481:United States / Q000453:epidemiology; D055815:Young Adult