Drug-Induced Sleep Endoscopy and Surgical Outcomes: A Multicenter Cohort Study
Por:
Green KK, Kent DT, D'Agostino MA, Hoff PT, Lin HS, Soose RJ, Boyd Gillespie M, Yaremchuk KL, Carrasco-Llatas M, Tucker Woodson B, Jacobowitz O, Thaler ER, Barrera JE, Capasso R, Liu SY, Hsia J, Mann D, Meraj TS, Waxman JA and Kezirian EJ
Publicada:
1 mar 2019
Ahead of Print:
27 dic 2018
Categoría:
Otorhinolaryngology
Resumen:
Objective To evaluate the association between findings of blinded reviews of preoperative drug-induced sleep endoscopy (DISE) examinations using the VOTE Classification and obstructive sleep apnea (OSA) surgical outcomes in a large multicenter, international cohort. Methods Retrospective, multi-center cohort study of adults without tonsillar hypertrophy who underwent pharyngeal surgery for OSA. The study included only participants without enlarged tonsils. Four independent reviewers performed blinded review of preoperative DISE videos using the VOTE Classification system and scoring of a primary structure contributing to airway obstruction. DISE findings were examined for an association with surgical outcomes with univariate analyses and multiple regression. Results Two hundred seventy-five study participants were included from 14 centers. Mean age was 51.4 +/- 11.8 years, and body mass index was 30.1 +/- 5.2 kg/m(2). There was moderate interrater reliability (kappa = 0.40-0.60) for DISE findings. Oropharyngeal lateral wall-related obstruction was associated with poorer surgical outcomes (adjusted odds ratio (AOR) 0.51; 95% CI 0.27, 0.93). Complete tongue-related obstruction was associated with a lower odds of surgical response in moderate to severe OSA (AOR 0.52; 95% CI 0.28, 0.98), with findings that were similar but not statistically significant in other analyses. Surgical outcomes were not clearly associated with the degree and configuration of velum-related obstruction or the degree of epiglottis-related obstruction. Surgical response was associated with tonsil size and body mass index (inversely). Conclusion DISE findings concerning the oropharyngeal lateral walls and tongue may be the most important findings of this evaluation tec
Filiaciones:
Green KK:
Department of Otolaryngology, University of Colorado School of Medicine, Denver, Colorado, U.S.A
Kent DT:
Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A
D'Agostino MA:
Southern New England Ear, Nose and Throat Group, Middlesex, Connecticut, USA
Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, U.S.A
Hoff PT:
University of Michigan, Department of Otolaryngology-Head and Neck Surgery, Ann Arbor, Michigan, U.S.A
Lin HS:
Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, U.S.A
Soose RJ:
UPMC Department of Otolaryngology Head and Neck Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, U.S.A
Boyd Gillespie M:
Department of Otolaryngology-Head and Neck Surgery, University of Tennessee Memphis, Memphis, Tennessee, U.S.A
Yaremchuk KL:
Department of Otolaryngology-Head and Neck Surgery, Henry Ford Health System, Detroit, Michigan, U.S.A
:
ENT department, Hospital Universitario Dr. Peset, Valencia, Spainc
Tucker Woodson B:
Department of Otolaryngology and Communication Sciences, Medical College of Wisconsi, Milwaukee, Wisconsin, U.S.A
Jacobowitz O:
ENT and Allergy Associates, New York, New York, U.S.A
Department of Otolaryngology, The Mount Sinai Hospital, New York, New York, U.S.A
Thaler ER:
Department of Otorhinolaryngology: Head and Neck Surgery, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
Barrera JE:
Department of Otolaryngology Head and Neck Surgery, Uniformed Services University, Washington, D.C., U.S.A
Endormir Sleep and Sinus Institute, San Antonio, Texas, U.S.A
Capasso R:
Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, U.S.A
Liu SY:
Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, U.S.A
Hsia J:
Department of Otolaryngology, Head and Neck Surgery, University of Minnesota Medical School, Minneapolis, Minnesota, U.S.A
Mann D:
University of Oklahoma Health Sciences Center, Department of Otolaryngology-Head Neck Surgery, Oklahoma City, Oklahoma, U.S.A
Meraj TS:
Department of Otolaryngology Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, U.S.A
Waxman JA:
Department of Otolaryngology Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, U.S.A
Kezirian EJ:
USC Caruso Department of Otolaryngology-Head Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California, U.S.A
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