Efficiency and Safety of Obstructive Sleep Apnea Cases Performed in an Ambulatory Surgery Center

Patients with obstructive sleep apnea (OSA) have increased perioperative risk, and procedures for OSA have traditionally been performed in a full-service, hospital-based operative room (HOR) often with inpatient admission postoperatively. We sought to compare the efficiency and safety of outpatient drug-induced sleep endoscopy (DISE), expansion pharyngoplasty (EP), hypoglossal nerve stimulation (HGNS), and septoplasty performed in patients with OSA in an ambulatory surgery center (ASC) versus HOR.

Retrospective Cohort Study.

Patients who underwent DISE, HGNS, septoplasty, tonsillectomy, and EP performed between January 1, 2021 and July 8, 2023 at a single academic HOR and ASC were included. We compared patient characteristics, in-room duration, recovery room times, and complications by surgical location.

One thousand two hundred seventy-three patients were identified; 727 underwent isolated DISE, 341 HGNS, 76 EP, 42 tonsillectomy, and 86 septoplasties. There were no significant baseline demographic differences between patients treated at the ASC as compared to the HOR except for a higher mean BMI (29.6 vs. 28.6 kg/m², p < 0.001) at the HOR. In-OR times in the ASC were no different than in the main OR for all procedures except HGNS, which, on average, took 4.0 min longer at the HOR (p = 0.03). Recovery room times at the ASC were significantly shorter for all procedures. There were very low rates of 30-day re-admissions and ER visits for procedures performed in both settings.

The OSA procedures analyzed in this study can safely be performed in an ASC with significantly reduced PACU times. Further research is needed to determine patient characteristics compatible with safe ambulatory OSA procedures.