Transoral Robotic Surgery vs. Non-Transoral Robotic Surgery Tongue
Resection for Obstructive Sleep Apnea
Abstract
Introduction: The objective was to compare transoral robotic surgery
(TORS) vs. non-TORS tongue resection procedures performed for
obstructive sleep apnea from 2010-14 using a national database, focusing
on patient characteristics, performance of concurrent procedures,
operative time, length of hospital stay, and postoperative complications
Methods: A cohort of adults undergoing TORS and non-TORS tongue
resection procedures was identified in the Nationwide Inpatient Sample,
a publicly-available national administrative database incorporating a
stratified sample of hospital discharge records. Outcomes were annual
case volumes, prolonged (≥3 days) hospital stay, and complications for
TORS and non-TORS tongue resection procedures. Statistical analyses
examined potential associations between the use of TORS and prolonged
hospital stay and complications, with adjustment for the performance of
concurrent procedures and specific patient and hospital characteristics.
Results: From 2010-14, 5185 hospital discharges included tongue
resection surgery to treat obstructive sleep apnea. There was a gradual
decline in overall volumes, with the proportion of TORS use showing an
initial increase, followed by a decrease. TORS patients were less likely
to undergo concurrent nasal surgery (14% vs. 45%, p<0.01),
but there was no association between the use of TORS and concurrent
palate/oropharyngeal or other hypopharyngeal surgery. TORS use was
associated with patient age, payor, and certain hospital
characteristics. TORS use was associated with an increased risk of
prolonged hospital stay (33% vs. 25%, p=0.045) and pulmonary
complications (8.4% vs. 6.0%, p=0.04) but not total complications
(7.7% vs. 7.4%, p=0.2). Conclusion: This study provides insight into
TORS use in tongue resection surgery for obstructive sleep apnea during
this period of early TORS adoption.