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Transoral Robotic Surgery vs. Non-Transoral Robotic Surgery Tongue Resection for Obstructive Sleep Apnea
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  • Jeehong Kim,
  • Barish Poole,
  • Steven Cen,
  • Nerses Sanossian,
  • Eric Kezirian
Jeehong Kim
University of Southern California Keck School of Medicine
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Barish Poole
NYU Winthrop Hospital
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Steven Cen
University of Southern California Keck School of Medicine
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Nerses Sanossian
University of Southern California Keck School of Medicine
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Eric Kezirian
University of Southern California Keck School of Medicine
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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.