Perioperative adverse events in patients with obstructive sleep apnea undergoing ambulatory ENT surgery: A systematic review and meta-analysis.

OBJECTIVE

Patients with obstructive sleep apnea (OSA) may be at increased risk for adverse events during ambulatory otorhinolaryngologic (ear, nose, and throat, [ENT]) surgery. There remains a gap in the literature quantifying these risks. This systematic review and meta-analysis aimed to evaluate the incidence of perioperative complications among patients with OSA undergoing ambulatory ENT surgeries.

METHODS

We systematically searched five databases from inception until February 2024 for studies on adult OSA patients undergoing ambulatory ENT surgeries. Primary outcomes included rates of composite adverse events, same-day admissions, emergency department (ED) visits, and readmissions. Meta-analysis, sensitivity analyses, and meta-regression were performed.

RESULTS

Sixteen studies (5453 patients) were included. The pooled incidence of composite adverse events was 10 % (95 % CI 7-14 %), with 12 % requiring same-day admission, 7 % presenting to the ED, and a 3 % readmission rate. Adverse events were mostly bleeding, pain, and dehydration. Expansion sphincter pharyngoplasty and other combined/multi-level procedures were generally associated with the most complications.

CONCLUSION

Our findings suggest that ENT procedures may be safely performed in ambulatory settings in appropriately selected patients with OSA. Improved patient selection and perioperative management may reduce complications, and careful risk stratification remains essential, particularly for combined/multi-level airway surgeries.