title: Sleep Surgery in the Elderly: Lessons from the National Surgical Quality Improvement Program.
abstract: Objective Assess the frequency and nature of postoperative complications following sleep surgery. Examine these issues specifically in elderly patients to provide guidance for their perioperative care. Study Design Retrospective cohort study. Setting American College of Surgeons National Surgical Quality Improvement Program. Methods We identified patients with obstructive sleep apnea undergoing sleep surgery procedures from 2006 to 2013 in the American College of Surgeons National Surgical Quality Improvement Program, a multi-institutional outcomes program designed to improve surgical quality. We analyzed patients by comparing age groups: <65 and ≥65 years. Summary data were analyzed, and multivariate regression was used to adjust for patient characteristics, comorbidities, and surgical procedure. Results We identified 2230 patients who had sleep surgery, which included 2123 patients <65 years old and 107 patients ≥65 years old. Elderly patients were significantly more likely to have hypertension requiring medication ( P < .001) and higher American Society of Anesthesiologists scores ( P < .001). There were no significant differences in the rates of nasal ( P = .87), palate ( P = .59), tongue base ( P = .73), and multilevel ( P = .95) surgery being performed on both groups of patients. Elderly patients had higher rates of wound complications and urinary tract infections as compared with younger patients. On multivariate analysis, age ≥65 was significantly associated with complications from sleep surgery (odds ratio, 2.35; 95% CI, 1.04-5.35). Conclusion Elderly patients undergoing sleep surgery have increased postoperative complication risk as compared with younger patients treated similarly. This information can help direct quality improvement efforts in the care of older patients.
authors.affiliation: 1 Department of Otolaryngology-Head and Neck Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Gouveia
authors.affiliation: 1 Department of Otolaryngology-Head and Neck Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
authors.forename: John D
authors.initials: JD
authors.lastname: Cramer
authors.affiliation: 2 Department of Otolaryngology-Head and Neck Surgery, Stanford University Medical Center, Stanford, California, USA.
authors.forename: Stanley Yung-Chuan
authors.initials: SY
authors.lastname: Liu
authors.affiliation: 2 Department of Otolaryngology-Head and Neck Surgery, Stanford University Medical Center, Stanford, California, USA.
authors.forename: Robson
authors.initials: R
authors.lastname: Capasso
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D009666:Nose / Q000601:surgery; D013517:Otorhinolaryngologic Surgical Procedures / Q000009:adverse effects* / Q000592:standards; D010160:Palate, Soft / Q000601:surgery; D011183:Postoperative Complications / Q000453:epidemiology*; D058996:Quality Improvement; D012189:Retrospective Studies; D020181:Sleep Apnea, Obstructive / Q000601:surgery*; D014059:Tongue / Q000601:surgery
keywords: NSQIP; National Surgical Quality Improvement Program; elderly; obstructive sleep apnea; sleep surgery