Combined nasal-palatopharyngeal surgery for obstructive sleep apnea: simultaneous or staged?

Our data indicate that surgical outcomes in a simultaneous surgery group were equivalent to those in a staged surgery group. The simultaneous type of surgery was more cost-effective in terms of total hospitalization expenses.

To compare the outcomes of two types of combined nasal-palatopharyngeal surgery (simultaneous and staged) for the treatment of obstructive sleep apnea (OSA).

A total of 85 consecutive patients were enrolled in the study. All patients had OSA and its associated symptoms, were type I according to the Fujita classification, stage 1 or 2 according to the Friedman classification and had nasal obstruction with nasal septal deviation. A modified form of uvulopalatopharyngoplasty (extended uvulopalatal flap surgery) and septomeatoplasty were used to correct upper airway abnormalities. Patients chose to have either a simultaneous (n = 55) or staged (n = 30) type of operation. All patients underwent overnight polysomnography at baseline and < or = 6 months after completion of the operations. Surgical results (reduction of OSA), patient satisfaction, complications and hospitalization expenses were compared between the two groups.

The two groups comprised body mass index- and respiratory disturbance index (RDI)-matched cohorts (p > 0.05). Postoperative decreases in RDI were significant in both groups (p < 0.001), and postoperative RDI was indistinguishable between the two groups (p = 0.77). Incidences of surgical complications, including tonsillar bleeding, nasal septal hematoma, nasal regurgitation and the sensation of a lump in the throat, were similar in the two groups (p = 0.35). The simultaneous surgery group incurred lower total hospitalization expenses than the staged surgery group (p < 0.001).