Author(s)
Sophia Linguiti, BA
Emma J. Anisman, BA
Abdulghafoor Alani, BS
Anika Walia, BA
Colin Huntley, MD
Affiliation(s)
Thomas Jefferson University Sidney Kimmel Medical College
Abstract:
Educational Objective: At the conclusion of this presentation, the participants should be able to assess the association between preoperative drug-induced sleep endoscopy (DISE) and postoperative outcomes in patients undergoing sleep surgery for obstructive sleep apnea (OSA), and interpret the impact of DISE on revision rates and sleep surgery postoperative complications. Understanding this relationship can guide surgical planning, improve patient selection, and potentially reduce the need for revision surgery, thereby enhancing overall treatment effectiveness and safety.
Objectives: To evaluate the impact of preoperative drug-induced sleep endoscopy (DISE) on long-term revision rates and short-term postoperative complications in patients undergoing sleep surgery for OSA.
Study Design: Retrospective cohort study using the TriNetX US Global Collaborative Network.
Methods: Adults diagnosed with OSA undergoing sleep surgery (including: palatopharyngoplasty or uvulopalatopharyngoplasty, tonsillectomy and/or adenoidectomy, pharyngoplasty, mandibular reconstruction, and genioglossus advancement) were identified and stratified based on whether they had undergone DISE within one year preoperatively. Patients receiving hypoglossal nerve stimulation were excluded. Outcomes included rates of additional sleep surgery and postoperative continuous positive airway pressure (CPAP) use occurring within five years, as well as 30-day postoperative complications.
Results: A total of 11,536 patients were included: 5,853 without and 5,853 with prior DISE. There was no significant difference in rates of revision surgery (2.55% vs 2.87%, RR 1.01, p=0.28) or CPAP use (3.09% vs 3.25%, RR 1.05, p=0.63) at 5-years post sleep surgery. However, patients with prior DISE had significantly higher rates of postoperative infection (2.17% vs. 1.45%, RR 1.49, p=0.004), and 30-day emergency visits (10.65% vs. 8.79%, RR 1.20, p=0.001). Postoperative bleeding was more common in the DISE group but did not reach statistical significance (7.32% vs. 6.61%, RR 1.11, p=0.127).
Conclusions: Preoperative DISE did not reduce the likelihood of future sleep surgery or postoperative CPAP use following sleep surgery. However, patients with prior DISE experienced higher rates of infection and healthcare utilization within 30 days. These findings highlight the need to further define the optimal role of DISE in sleep surgery planning for OSA.