A Comprehensive Strategy for Improving Nasal Outcomes After Large Maxillomandibular Advancement for Obstructive Sleep Apnea

Abdelwahab, Mohamed; Poomkonsarn, Sasikarn; Ren, Xiatong; Awad, Michael; Capasso, Robson; Riley, Robert; Most, Sam P.; Liu, Stanley Yung‐Chuan

doi:10.1089/fpsam.2020.0569

Cited by 12 publications

(8 citation statements)

References 36 publications

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“…With classic MMA techniques, persistent nasal obstruction is reported to be as high as 18.7% from 379 patients over 15 years 1686 . Nasal obstruction rates can be reduced to 6.5% with modifications including pre‐MMA maxillary expansion, concurrent septoplasty, piriformplasty, and emphasis on postoperative nasal and sinus rinsing 1866 . There is a need to update evidence on adverse events in contemporary MMA.…”

Section: Surgical Treatment For Osamentioning

confidence: 99%

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International Consensus Statement on Obstructive Sleep Apnea

Chang

Goldberg

Alt

et al. 2023

Int Forum Allergy Rhinol

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118

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Background: Evaluation and interpretation of the literature on obstructive sleep apnea (OSA) allows for consolidation and determination of the key factors important for clinical management of the adult OSA patient. Toward this goal, an international collaborative of multidisciplinary experts in sleep apnea evaluation and treatment have produced the International Consensus statement on Obstructive Sleep Apnea (ICS:OSA). Methods: Using previously defined methodology, focal topics in OSA were assigned as literature review (LR), evidence-based review (EBR), or evidencebased review with recommendations (EBR-R) formats. Each topic incorporated the available and relevant evidence which was summarized and graded on study quality. Each topic and section underwent iterative review and the ICS:OSA was created and reviewed by all authors for consensus. Results: The ICS:OSA addresses OSA syndrome definitions, pathophysiology, epidemiology, risk factors for disease, screening methods, diagnostic testing types, multiple treatment modalities, and effects of OSA treatment on multiple OSA-associated comorbidities. Specific focus on outcomes with positive airway pressure (PAP) and surgical treatments were evaluated. Conclusion:This review of the literature consolidates the available knowledge and identifies the limitations of the current evidence on OSA. This effort aims to create a resource for OSA evidence-based practice and identify future research needs. Knowledge gaps and research opportunities include improving the metrics of OSA disease, determining the optimal OSA screening paradigms, developing strategies for PAP adherence and longitudinal care, enhancing selection of PAP alternatives and surgery, understanding health risk outcomes, and translating evidence into individualized approaches to therapy.

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Section: Surgical Treatment For Osamentioning

confidence: 99%

“…1686 Nasal obstruction rates can be reduced to 6.5% with modifications including pre-MMA maxillary expansion, concurrent septoplasty, piriformplasty, and emphasis on postoperative nasal and sinus rinsing. 1866 There is a need to update evidence on adverse events in contemporary MMA. (Table IX…”

Section: Ixd6bmentioning

confidence: 99%

International Consensus Statement on Obstructive Sleep Apnea

Chang

Goldberg

Alt

et al. 2023

Int Forum Allergy Rhinol

Self Cite

118

View full text Add to dashboard Cite

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“…Over the years, targeted approaches to surgically manage OSA have given physicians more options to identify and treat patients more effectively. [19][20][21][22][23][24][25][26][27] This concept, wherein surgical management of a chronic condition lowers overall health care use and economic burden, is not new. A Swedish study analyzing the difference in health care use in obese patients found bariatric surgery to be more cost-effective when compared to medical management and was associated with fewer lifetime events (transient ischemic attacks, type 2 diabetes).…”

Section: Discussionmentioning

confidence: 99%

“…Over the years, targeted approaches to surgically manage OSA have given physicians more options to identify and treat patients more effectively 19‐27 . This concept, wherein surgical management of a chronic condition lowers overall health care use and economic burden, is not new.…”

Section: Discussionmentioning

confidence: 99%

Value of Surgical and Nonsurgical Treatment for Sleep Apnea: A Closer Look at Health Care Utilization

Abdelwahab

Marques

Huang

et al. 2023

Otolaryngol.--head neck surg.

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Objective To determine how surgery, continuous positive airway pressure (CPAP), and no treatment impact health care utilization in patients who have obstructive sleep apnea (OSA). Study Design This is a retrospective cohort study of patients between the ages of 18 and 65 that were diagnosed with OSA (9th International Classification of Diseases) from January 2007 to December 2015. Data were collected over 2 years, and prediction models were generated to evaluate trends over time. Setting A population‐based study using real‐world data and insurance databases. Methods A total of 4,978,649 participants were identified, all with at least 25 months of continuous enrollment. Patients with previous soft tissue procedures not approved for OSA (nasal surgery), or without continuous insurance coverage were excluded. A total of 18,050 patients underwent surgery, 1,054,578 were untreated, and 799,370 received CPAP. IBM Marketscan Research database was utilized to describe patient‐specific clinical utilization, and expenditures, across outpatient, and inpatient services, and medication prescriptions. Results When the cost of the intervention was eliminated in the 2‐year follow‐up, the monthly payments of group 1 (surgery) were significantly less than group 3 (CPAP) in overall, inpatient, outpatient, and pharmaceutical payments (p < .001). The surgery group was associated with less cumulative payments compared to the other 2 groups when the cost of the intervention (CPAP or surgery) was eliminated in all comorbidities and age groups. Conclusion Treating OSA with surgery can lessen overall health care utilization compared to no treatment and CPAP.

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“…Exclusion criteria were upper airway procedures that did not include UPPP, such as skeletal procedures, maxillomandibular advancement, distraction osteogenesis maxillary expansion, or isolated genioglossus advancement (GGA). 31,32 Antibiotic prescription was considered when it was given prior to the complication day, to define the actual benefit or hazard from its use.…”

Section: Methodsmentioning

confidence: 99%

Perioperative Antibiotic Use in Sleep Surgery: Clinical Relevance

Abdelwahab

Marques

Previdelli

et al. 2021

Otolaryngol.--head neck surg.

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Objective Upper airway surgery is a common therapeutic approach recommended for patients with obstructive sleep apnea (OSA) to decrease disease burden. We aimed to evaluate the effect of perioperative antibiotic prescription on complication rates. Study Design Retrospective cohort (national database). Setting Tertiary referral center. Methods This is a retrospective study of a large national health care insurance database (Truven MarketScan) from 2007 to 2015. Subjects diagnosed with OSA who had uvulopalatopharyngoplasty (UPPP) were included and stratified in single versus multilevel surgery. Other variables included smoking, age, sex, antibiotic prescription, and comorbidities based on the Elixhauser index. Evaluated outcomes were postoperative bleeding, intubation, pneumonia, superficial surgical site infection, tracheostomy, and hospital readmission. A multivariate regression model was created to assess each complication. Results A total of 5,798,528 subjects received a diagnosis of OSA, of which 39,916 were >18 years old and underwent UPPP, either alone or with additional procedures. The mean age was 43 years, and 73.4% were male. Antibiotic prescription was associated with less bleeding in UPPP alone, UPPP with nasal surgery, and UPPP with nasal and tongue surgery ( P < .001, P < .001, and P = .006, respectively). It was also associated with a lower prevalence of surgical site infection, pneumonia, tracheostomy, intubation, and hospital readmission ( P < .001). On a multivariate model, antibiotic prescription was significantly associated with a decreased rate of complications. Conclusions Although former studies recommended against the use of antibiotics after tonsillectomy, our results suggest that antibiotic prescription after UPPP for OSA was associated with less bleeding, surgical site infection, pneumonia, intubation, tracheostomy, and hospital readmission 30 days postoperatively.

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A Comprehensive Strategy for Improving Nasal Outcomes After Large Maxillomandibular Advancement for Obstructive Sleep Apnea

Cited by 12 publications

References 36 publications

International Consensus Statement on Obstructive Sleep Apnea

International Consensus Statement on Obstructive Sleep Apnea

Value of Surgical and Nonsurgical Treatment for Sleep Apnea: A Closer Look at Health Care Utilization

Perioperative Antibiotic Use in Sleep Surgery: Clinical Relevance

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