Disparities in Utilization of Jaw Surgery for Treatment of Sleep Apnea: A Nationwide Analysis

Garg, Rajnish; Shan, Ying; Havlena, Jeffrey; Afifi, Ahmed M.

doi:10.1097/gox.0000000000001047

Cited by 5 publications

(15 citation statements)

References 30 publications

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“…Despite males comprising a larger portion of our sleep-surgery subset (67.2%), multivariable analysis did not demonstrate an independent association between sex 11,24,25 These trends, along with our data, indicate that, over time, more sleep surgeries have been performed for women. Sleep surgery research often includes primarily male participants 26 ; therefore, it is difficult to extrapolate the results of prior studies to our more diverse sleep surgery population.…”

Section: Discussioncontrasting

confidence: 47%

Characteristics of Adults Undergoing Soft Tissue and Orthognathic Surgery for Obstructive Sleep Apnea

et al. 2023

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Objective: To identify clinical and demographic characteristics of adults with obstructive sleep apnea (OSA) undergoing soft tissue and orthognathic sleep surgery, assess temporal trends in surgery type and proportion of women undergoing surgery, and provide clinical perspective before wide-spread implementation of hypoglossal nerve stimulation (HGNS).Methods: In a retrospective cohort study, adults diagnosed with OSA from 2009 to 2016 were identified in a large integrated healthcare system. Characteristics between cohort members who did and did not undergo sleep surgeries were compared. Multivariable logistic regression models examined associations of different characteristics with whether surgery was performed.Results: Of 172,216 adults with OSA, 2,262 (1.3%) underwent sleep surgery during 2009-2017. The most common sleep surgery was palate surgery (56.9%), which decreased proportionately over time. In multivariable analysis, older age and obesity were associated with lower odds of undergoing surgery. Those who underwent tonsillectomy and adenoidectomy were more likely to have larger tonsils and not require additional surgery, whereas tongue reduction recipients were more likely to have severe OSA and require multiple surgery types. The proportion of women undergoing surgery increased over time (p < 0.001 from trend test).Conclusion: Clinical and demographic characteristics associated with soft tissue and orthognathic sleep surgery were identified in a large adult cohort prior to widespread implementation of HGNS. An increase in sleep surgery among women and a decrease in palate surgery over time were observed. The findings provide clinical perspective on sleep surgery performed prior to implementation of HGNS and may inform future studies examining its associations with patient characteristics.

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Section: Discussioncontrasting

confidence: 47%

Characteristics of Adults Undergoing Soft Tissue and Orthognathic Surgery for Obstructive Sleep Apnea

et al. 2023

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“…However, this statistically significant correlation seems to be mainly due to one specific year, as half of all 20 complication cases in the outpatient setting (10/20) occurred in 2014. Due to escalating health care costs and limited reimbursement from insurance plans, OS patients increasingly considered the more cost-effective outpatient surgery during the early and mid-2010 decade [ 41 , 42 , 43 ]. This shift to outpatient care is also reflected in our analysis, with a skyrocketing number of outpatient OS in 2014: in this year, we recorded a total of 118 OS procedures, of which 85% (n = 100) were performed in the outpatient setting.…”

Section: Discussionmentioning

confidence: 99%

Early Outcomes and Risk Factors in Orthognathic Surgery for Mandibular and Maxillary Hypo- and Hyperplasia: A 13-Year Analysis of a Multi-Institutional Database

Knoedler

Baecher

Hoch

et al. 2023

JCM

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Background: Orthognathic surgery (OS) is a frequently performed procedure for the correction of dentofacial deformities and malocclusion. Research on OS is mostly limited to single-surgeon experience or single-institutional reports. We, therefore, retrospectively analyzed a multi-institutional database to investigate outcomes of OS and identify risk factors for peri- and postoperative complications. Methods: We reviewed the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database (2008–2020) to identify patients who underwent OS for mandibular and maxillary hypo- and hyperplasia. The postoperative outcomes of interest included 30-day surgical and medical complications, reoperation, readmission, and mortality. We also evaluated risk factors for complications. Results: The study population included 674 patients, 48% of whom underwent single jaw surgery, 40% double jaw surgery, and 5.5% triple jaw surgery. The average age was 29 ± 11 years, with an equal gender distribution (females: n = 336; 50%, males: n = 338; 50%). Adverse events were relatively rare, with a total of 29 (4.3%) complications reported. The most common surgical complication was superficial incisional infection (n = 14; 2.1%). While the multivariable analysis revealed isolated single lower jaw surgery (p = 0.03) to be independently associated with surgical complication occurrence, it also identified an association between the outpatient setting and the frequency of surgical complications (p = 0.03) and readmissions (p = 0.02). In addition, Asian ethnicity was identified as a risk factor for bleeding (p = 0.003) and readmission (p = 0.0009). Conclusion: Based on the information recorded by the ACS-NSQIP database, our analysis underscored the positive (short-term) safety profile of OS. We found OS of the mandible to be associated with higher complication rates. The calculated risk role of OS in the outpatient setting warrants further investigation. A significant correlation between Asian OS patients and postoperative adverse events was found. Implementation of these novel risk factors into the surgical workflow may help facial surgeons refine their patient selection and improve patient outcomes. Future studies are needed to investigate the causal relationships of the observed statistical correlations.

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“…10 With respect to surgical treatment of obstructive sleep apnea (OSA), Black and Hispanic patients have lower odds of receiving jaw surgery. 11…”

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confidence: 99%

“…10 With respect to surgical treatment of obstructive sleep apnea (OSA), Black and Hispanic patients have lower odds of receiving jaw surgery. 11 An important facet of health care disparities stems from underrepresentation in the clinical trials upon which the evidence for treatment is based. The sample population in clinical trials is meant to represent the intended treatment population of the given disease.…”

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confidence: 99%

“…Black patients are less likely than their White counterparts to receive surgical intervention for head and neck squamous cell carcinomas, 9 and Black patients with differentiated thyroid cancer are less likely than White patients to receive a central neck dissection or postoperative radioactive iodine 10 . With respect to surgical treatment of obstructive sleep apnea (OSA), Black and Hispanic patients have lower odds of receiving jaw surgery 11 …”

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confidence: 99%

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Representation of Race and Sex in Sleep Surgery Studies

Debbaneh¹,

Ramirez

Block‐Wheeler³

et al. 2022

Otolaryngol.--head neck surg.

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Objective Obstructive sleep apnea (OSA) is a highly prevalent disorder with many treatment modalities, including surgical intervention. While OSA is known to be more prevalent in males and Black Americans, the representation of race and sex in sleep surgery studies is unknown. The aim of this systematic review is to assess the race and sex demographics represented in sleep surgery studies relative to known OSA demographics. Data Sources PubMed, MEDLINE, and OVID databases. Review Methods A systematic review was conducted to identify studies published between 2016 and 2020 that investigated sleep outcomes following nonnasal surgical intervention for OSA in adults. Pooled racial, ethnic, and sex data of the enrolled subjects in selected studies were analyzed. Results The 148 included studies comprised 13,078 patients. Of the 137 studies that reported sex, 84.0% of participants were male, exceeding the population prevalence of OSA in males, which is estimated at 66%. Only 13 studies reported racial/ethnic demographic data. Of these, 87.8% of patients were White. Out of 30 studies of primarily American patients, only 4 reported race demographic data, with an average of 82.8% White participants. Conclusion There is a racial/ethnic and sex inclusion bias among sleep surgery studies. Future studies should better document the demographics of enrolled participants as well as recruit participants who better represent the demographics of adults with OSA in the general population.

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Disparities in Utilization of Jaw Surgery for Treatment of Sleep Apnea: A Nationwide Analysis

Cited by 5 publications

References 30 publications

Characteristics of Adults Undergoing Soft Tissue and Orthognathic Surgery for Obstructive Sleep Apnea

Characteristics of Adults Undergoing Soft Tissue and Orthognathic Surgery for Obstructive Sleep Apnea

Early Outcomes and Risk Factors in Orthognathic Surgery for Mandibular and Maxillary Hypo- and Hyperplasia: A 13-Year Analysis of a Multi-Institutional Database

Representation of Race and Sex in Sleep Surgery Studies

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