Upper airway stimulation for obstructive sleep apnea: The surgical learning curve.

ABSTRACT

OBJECTIVES/HYPOTHESIS: To determine the effect of surgeon experience with an upper airway stimulation (UAS) system on surgical time and complication rates. STUDY DESIGN: Retrospective review. METHODS: Surgical procedure times and complication rates observed in patients implanted at 22 study centers as part of a phase III, multicenter surgical trial of upper airway nerve stimulation therapy for obstructive sleep apnea were reviewed. RESULTS: The study included 126 subjects who were predominantly male (83%), with a mean age of 54.5 years (range = 31-80 years), and the mean body mass index was 28.4 ± 2.6. There were an average of 5.7 (range = 1-22) surgical implants per site, with an average surgical time of 2.52 ± 0.98 hours (range = 1.08-6.0 hours). The surgical implant time decreased significantly with surgeon experience, from 2.98 ± 1.18 hours for a surgeon's first implant (n = 22) to 2.08 ± 0.55 hours for the fifth implant (n = 10, P = .025). Surgical time was inversely correlated with the site implant number (rho = -0.334, P < .001). Procedure-specific complications were uncommon and self-limited and did not decrease appreciably with increasing experience. CONCLUSIONS: Surgical time for implantation of the UAS system decreased significantly after the first five implants and then stabilized. The rate of surgical complications did not decrease with surgeon experience, although this may be attributable to the low overall rate of serious surgical complications and low number of implants at some centers. LEVEL OF EVIDENCE 4.