 |
|
Risk Factors for Serious Complication After Uvulopalatopharyngoplasty
Eric J. Kezirian, MD, MPH;
Edward M. Weaver, MD, MPH;
Bevan Yueh, MD, MPH;
Shukri F. Khuri, MD;
Jennifer Daley, MD;
William G. Henderson, PhD
Arch Otolaryngol Head Neck Surg. 2006;132:1091-1098.
Objective To test the hypothesis that comorbidity, performance of concurrent sleep apnea procedures in addition to uvulopalatopharyngoplasty, body mass index, apnea-hypopnea index, and lowest oxygen saturation are risk factors for serious perioperative complications after uvulopalatopharyngoplasty.
Design Prospective cohort and nested case-control studies.
Setting United States Veterans Affairs medical centers.
Patients A prospective cohort of 3130 consecutive adult inpatients who underwent uvulopalatopharyngoplasty from 1991 to 2001 was retrospectively analyzed from the Veterans Affairs National Surgical Quality Improvement Program database to determine the relationship between perioperative complications and both concurrent procedures and medical comorbidity. A nested case-control analysis was conducted on 43 cases with complications and 212 controls without complications from the cohort. Controls were matched on age, sex, year of operation, and concurrent surgery; this case-control analysis enabled the study of body mass index, apnea-hypopnea index, and lowest oxygen saturation, which were not available in the cohort database. Multivariate logistic regression measured associations between risk factors and complications, adjusting or controlling for age, sex, race, smoking status, year of uvulopalatopharyngoplasty, and presence of any concurrent procedure.
Main Outcome Measure Sixteen specific serious perioperative complications, including 30-day mortality.
Results The cohort included 3130 veterans (97% were men aged 50 ± 11 [mean ± SD] years). In the cohort study, comorbidity was associated with serious complication: the adjusted risk ratio was 1.96 (95% confidence interval, 1.16-3.18) for each increase in American Society of Anesthesiologists class. Concurrent nonnasal procedures increased the risk of complication compared with no concurrent procedures (adjusted risk ratio, 4.94; 95% confidence interval, 2.34-10.4). In the case-control analyses, the apnea-hypopnea index, body mass index, and medical comorbidity were each associated with serious complication after adjustment for confounding variables, but this study had insufficient power to determine if these risk factors were independent of each other. Concurrent retrolingual procedures demonstrated an independent association with complication after adjustment for confounders. The lowest oxygen saturation was not associated with serious complication.
Conclusions Apnea-hypopnea index, body mass index, and medical comorbidity were each associated with serious complication; however, the low complication rate precluded demonstration of associations independent of each other. Concurrent retrolingual procedures were also associated with serious complication, but the cumulative risk of separate retrolingual procedures is unknown.
Author Affiliations: Departments of Otolaryngology–Head and Neck Surgery, University of California, San Francisco, School of Medicine (Dr Kezirian), Veterans Affairs Puget Sound Health Care System, Seattle, Wash (Drs Weaver and Yueh), and University of Washington School of Medicine, Seattle (Drs Weaver and Yueh); Department of Surgery, Brockton–West Roxbury Veterans Affairs Medical Center, West Roxbury, Mass, and Harvard Medical School, Boston, Mass (Dr Khuri); Tenet HealthCare, Dallas, Tex, and Department of Community and Family Medicine, Dartmouth Medical School, Hanover, NH (Dr Daley); Department of Health Services, University of Washington School of Public Health and Community Medicine, Seattle (Dr Yueh); and Colorado Health Outcomes Program and Department of Preventive Medicine and Biometrics, University of Colorado Health Sciences Center, Denver (Dr Henderson).
|
