Temporal trends in sleep apnea surgery: 1993-2010

Abstract

Objectives/hypothesis: Growing evidence supports the use of multilevel surgery to effectively address obstructive sleep apnea (OSA). We sought to characterize changes in the patterns of surgical sleep care over time.

Study design: Repeated cross-sectional study.

Methods: Discharge data from the US Nationwide Inpatient Sample for 232,470 patients who underwent nasal, palatal, or hypopharyngeal procedures for sleep disordered breathing or OSA from 1993 to 2010 were analyzed using cross-tabulations and multivariate regression modeling.

Results: Inpatient sleep surgical procedures increased from 97,363 performed in 1993-2000 to 135,107 in 2001-2010. Sleep surgery in 2001-2010 was associated with increased hypopharyngeal surgery (relative risk ratio [RRR] = 3.6, 95% confidence interval [CI] = 2.6-4.9, P < .001), tongue radiofrequency/midline glossectomy (RRR = 5.1, 95% CI = 3.4-7.5, P < .001), hyoid suspension (RRR = 6.8, 95% CI = 3.8-12.5, P < .001), nasal surgery (RRR = 1.3, 95% CI = 1.1-1.5, P = 0.002), and multilevel surgery (RRR = 5.6, 95% CI = 3.8-9.4, P < .001) and decreased tracheostomy (RRR = 0.58, 95% CI = 0.49-0.68, P < .001) compared to 1993-2000. Patients undergoing sleep surgery in 2001-2010 were more likely to have an OSA diagnosis (RRR = 1.9, 95% CI = 1.4-2.5, P < .001), obesity (RRR = 1.5, 95% CI = 1.4-1.7, P < .001), and advanced comorbidity (RRR = 2.4, 95% CI = 2.0-2.8, P < .001). In 2001-2010, surgeons (>23 cases/yr) in the top-volume quintile were more likely to perform hypopharyngeal procedures (RRR = 2.4, 95% CI = 1.7-3.4, P < .001,) and to be associated with teaching hospitals (RRR = 1.5, 95% CI = 1.0-2.2, P = 0.034) and less likely to perform tracheostomy (RRR = 0.27, 95% CI = 0.18-0.40, P < .001). However, they represented only 17% of surgeons performing sleep surgery in contrast to surgeons in the bottom-volume quintile, who performed 35% of cases.

Conclusions: These data reflect changing trends in the surgical management of OSA, with meaningful differences in the type of surgical care provided by high-volume surgeons and a significant increase in surgical sleep procedures, particularly nasal and hypopharyngeal surgery.

Keywords: Nationwide Inpatient Sample; Sleep apnea; comorbidities; surgery.