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Published on: December 6, 2016
Temporal trends in inpatient pediatric sleep apnea surgery: 1993-2010
David F Smith1, Ting Sa2, Matthew Fenchel2
1Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A.
Insights
Pediatric sleep surgery for obstructive sleep apnea (OSA) increased significantly, with more nasal and hypopharyngeal procedures. Multilevel surgery, however, remains uncommon in children, unlike in adults.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Sleep Medicine
Background:
- Pediatric obstructive sleep apnea (OSA) is a growing concern.
- Surgical interventions are a key management strategy for pediatric OSA.
- Understanding trends in surgical care is crucial for optimizing treatment.
Purpose of the Study:
- To analyze changes in inpatient surgical sleep care patterns for children over time.
- To compare pediatric surgical trends with those observed in adult populations.
- To identify shifts in specific surgical procedures for pediatric sleep-disordered breathing.
Main Methods:
- A repeated cross-sectional study design was employed.
- Analysis of U.S. Nationwide Inpatient Sample discharge data from 1993 to 2010.
- Inclusion of 125,691 inpatient procedures for sleep-disordered breathing or OSA in children.
Main Results:
- Inpatient surgical sleep procedures for children rose from 45,671 (1993-2000) to 80,020 (2001-2010).
- Tonsillectomy remained the most frequent procedure; nasal and hypopharyngeal surgeries, including supraglottoplasty, significantly increased.
- Multilevel surgery did not show a significant increase, and tracheostomies decreased over the study period.
Conclusions:
- Surgical management of pediatric OSA shows evolving trends, favoring nasal and hypopharyngeal approaches.
- Lingual tonsillectomy and supraglottoplasty are increasingly utilized.
- Unlike adults, multilevel surgery for pediatric sleep-disordered breathing is not yet standard practice.
Objectives/Hypothesis:
We sought to characterize changes in the patterns of inpatient surgical sleep care over time and ascertain if these changes were consistent with previously reported trends in adult surgical sleep care.
Study Design:
Repeated cross-sectional study.
Methods:
Discharge data from the U.S. Nationwide Inpatient Sample for 125,691 nasal, palatal, or hypopharyngeal procedures in children for sleep-disordered breathing or obstructive sleep apnea (OSA) from 1993 to 2010 were analyzed using cross-tabulations and multivariate regression modeling.
Results:
Inpatient surgical sleep procedures increased from 45,671 performed in 1993 to 2000 (study period 1) to 80,020 in 2001 to 2010 (study period 2). Overall, patients were commonly male (61.3%), privately insured (46.8%), 2 to 6 years old (39.4%), and white (36.4%). Obesity was reported in 4.6% and 6.7% of children during study periods 1 and 2, respectively (P < .0001). Tonsillectomy (with and without adenoidectomy) was the most commonly performed procedure in both study periods. With the exception of uvulopalatopharyngoplasty and tracheostomy, all sleep procedures increased over time; however, multilevel surgery did not significantly increase (P = .28). Children who underwent sleep surgery during study period 2 were more likely to receive a supraglottoplasty (P = .0125) and to undergo procedures at high-volume hospitals (P = .0311), and less likely to undergo a tracheostomy (P < .0001).
Conclusions:
These data reflect changing trends in the surgical management of pediatric OSA, with significant increases in nasal and hypopharyngeal procedures, particularly lingual tonsillectomy and supraglottoplasty. Unlike the trend in adults, multilevel surgery in children with sleep disordered breathing or OSA has not yet been integrated into routine clinical practice.
Level Of Evidence:
2C Laryngoscope, 127:1235-1241, 2017.
