Prognostic factors in otorhinolaryngological sleep surgery

BACKGROUND: Despite good results, the success rate of sleep surgery does not reach 100%. The identification of predictors of surgical success is becoming mandatory in order to choose the better treatment for each patient. The aim of this retrospective study was to evaluate the clinical characteristics of the patients who underwent otorhinolaryngological sleep surgery and to identify prognostic factors. METHODS: Between June 2010 and May 2015, 31 patients with obstructive sleep apnea syndrome were evaluated and underwent sleep surgery at our Division. All the patients underwent a pre-operative complete physical examination, polygraphy and drug-induced sleep endoscopy. Receiver operator curves were created and the area under the curve (AUC) calculated for each prognostic factor. The best cut-offs were identified. Moreover, prognostic factors were combined to obtain a better predictor. RESULTS: Success rate was 74.2%. Analyzing the differences in clinical parameters between patients with and without surgical success, preoperative Apnea-Hypopnea Index (AHI) was the only variable that had a statistically significant variation. AUC was 0.82, and the best cut-off was 40. Summing age, Body Mass Index (BMI), and AHI (SUM), AUC was 0.87, with the best cut-off of 110. Therefore, patients with an AHI≤ 40 or a SUM≤110 had a higher probability of success. CONCLUSIONS: The sum of age, BMI, and AHI is a good predictor of surgical success, better than AHI alone. The identification of prognostic factors in sleep surgery is important to select the better treatment for each patient.