Introduction
There is a push towards day surgery as the default option for elective surgery in the UK. It is increasingly recognized that day surgery is cost-effective, reduces hospital-acquired infections and thromboembolic events, and increases patient satisfaction (1). The range and complexity of procedures that can be performed as day surgery have also expanded, facilitated by dedicated day case units, experienced teams, and protocols.
Surgical patients with obstructive sleep apnoea (OSA) have a higher risk of perioperative complications such as hypoxaemia, cardiac arrhythmias and myocardial infarction (2). These patients also often have multiple comorbidities associated with OSA such as hypertension, diabetes or heart failure. Anaesthetic agents and sedatives given during surgery may further exacerbate upper airway collapsibility in these patients and worsen sleep apnoea. Strong opioid analgesics given during and after surgery for pain relief may cause respiratory depression in these patients that are already vulnerable. Thus, patients with OSA are often monitored in intensive care units post-operatively.
In patients with OSA, nasal surgery can improve symptoms, reduce the severity of OSA and also improve compliance with CPAP (continuous positive airway pressure) devices. Palatopharyngeal surgery optimizes upper airway anatomy and again may provide symptomatic relief in these patients as well as reduce the severity of OSA. In the UK, nasal surgery and palatopharyngeal surgery are generally performed as day cases in patients without OSA. In patients with OSA, they are more likely to be inpatients and may even require post-operative monitoring in a high dependency or intensive care setting. This is due to concerns regarding serious respiratory or cardiac complications post-operatively, and mortality has been reported (3). There is also concern that nasal packing in patients with OSA makes the use of CPAP post-operatively more difficult and thus increases risk of hypoxaemia and respiratory complications. Inpatient bed shortages often lead to these operations being cancelled. Recent day surgery guidelines suggest OSA is not an absolute contraindication for same day discharge (1). However, no recommendation was provided for airway surgery specifically due to the lack of evidence and inherently higher risks with these patients (4).
Our aim was to conduct a systematic review to evaluate current evidence base on the feasibility and safety of day case nasal and/or palatopharyngeal surgery in patients with OSA or suspected OSA.