Association of cumulative surgeon volume and risk of complications in adult uvulopalatopharyngoplasty: a population-based study in Taiwan.

STUDY

OBJECTIVES

Patients with obstructive sleep apnea undergoing upper airway surgery are known to have an increased perioperative risk, however, the effect of surgeon volume on this risk is largely unknown. We compared the 30-day readmission, bleeding, and mortality rates in adult patients with obstructive sleep apnea undergoing uvulopalatopharyngoplasty by cumulative surgeon volume. The objective of this study is to compare the risks of complications among different cumulative surgeon volume groups in adult patients undergoing uvulopalatopharyngoplasty and multilevel surgery.

METHODS

In this retrospective study, data of all adult inpatients (aged older than 18 years) who underwent uvulopalatopharyngoplasty in Taiwan between 2000 and 2012 were identified from the National Health Insurance Research Database and then analyzed. Using mixed-effect logistic regression, we compared the risks of major complications in patients undergoing uvulopalatopharyngoplasty alone, uvulopalatopharyngoplasty with nasal surgery, and uvulopalatopharyngoplasty with tongue or hypopharyngeal surgery according to groups of cumulative surgeon volume (divided into four quartiles).

RESULTS

A total of 36,483 adults were identified (mean age, 38.6 years; 73.7% men). When quartile 4 was used as reference, very low surgeon volume (quartile 1) was associated with higher risks of readmission within 30 days (adjusted odds ratio [aOR] 1.35, 95% confidence interval [CI] 1.17-1.57, P < .001), in-hospital death (aOR, 6.14, 95% CI 1.33-28.27, P = .020), and 30-day mortality (aOR, 4.90, 95% CI 1.83-13.09, P = .002).

CONCLUSIONS

Higher complication rates in uvulopalatopharyngoplasty appear to be associated with very low cumulative surgeon volume.