title: Upper airway stimulation for obstructive sleep apnea: The surgical learning curve.
abstract: OBJECTIVE
  To determine the effect of surgeon experience with an upper airway stimulation (UAS) system on surgical time and complication rates.
  
  
  METHODS
  Retrospective review.
  
  
  METHODS
  Surgical procedure times and complication rates observed in patients implanted at 22 study centers as part of a phase III, multicenter surgical trial of upper airway nerve stimulation therapy for obstructive sleep apnea were reviewed.
  
  
  RESULTS
  The study included 126 subjects who were predominantly male (83%), with a mean age of 54.5 years (range = 31-80 years), and the mean body mass index was 28.4 ± 2.6. There were an average of 5.7 (range = 1-22) surgical implants per site, with an average surgical time of 2.52 ± 0.98 hours (range = 1.08-6.0 hours). The surgical implant time decreased significantly with surgeon experience, from 2.98 ± 1.18 hours for a surgeon's first implant (n = 22) to 2.08 ± 0.55 hours for the fifth implant (n = 10, P = .025). Surgical time was inversely correlated with the site implant number (rho = -0.334, P < .001). Procedure-specific complications were uncommon and self-limited and did not decrease appreciably with increasing experience.
  
  
  CONCLUSIONS
  Surgical time for implantation of the UAS system decreased significantly after the first five implants and then stabilized. The rate of surgical complications did not decrease with surgeon experience, although this may be attributable to the low overall rate of serious surgical complications and low number of implants at some centers.
  
  
  METHODS
  4.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Alexander W
authors.initials: AW
authors.lastname: Murphey
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Andrew B
authors.initials: AB
authors.lastname: Baker
authors.affiliation: Division of Sleep Surgery, Department of Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Ryan J
authors.initials: RJ
authors.lastname: Soose
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of South Florida, Tampa, Florida, U.S.A.
authors.forename: Tapan A
authors.initials: TA
authors.lastname: Padyha
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Shaun A
authors.initials: SA
authors.lastname: Nguyen
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Xiao
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: M Boyd
authors.initials: MB
authors.lastname: Gillespie
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004599:Electric Stimulation Therapy / Q000295:instrumentation*; D004567:Electrodes, Implanted; D005260:Female; D006801:Humans; D007002:Hypoglossal Nerve; D059032:Learning Curve; D008297:Male; D008875:Middle Aged; D017286:Polysomnography; D012119:Respiration; D012189:Retrospective Studies; D020181:Sleep Apnea, Obstructive / Q000503:physiopathology / Q000601:surgery*
keywords: Obstructive sleep apnea; hypoglossal nerve; snoring; upper airway stimulation