Michael W Sim1, Jeffrey J Stanley. 1. Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, U.S.A.
Abstract
OBJECTIVES/HYPOTHESIS: Most patients with obstructive sleep apnea (OSA) have multilevel obstruction. Improved outcomes with multilevel surgery compared to isolated palatal surgery have been well documented. Despite this, surgical practice patterns in the United States have been slow to change. The purpose of this study was to evaluate whether current practice patterns are a reflection of limited surgical residency training in hypopharyngeal procedures. STUDY DESIGN: Cross-sectional Internet survey. METHODS: Program directors from 103 accredited U.S. otolaryngology residency programs were surveyed regarding past (2000, 2005) and more recent (2010) resident surgical competency in operative techniques for treatment of OSA. RESULTS: Of the 48 survey respondents, 85%, 90%, and 100% reported resident surgical competency for oropharyngeal procedures in 2000, 2005, and 2010, respectively. Uvulopalatopharyngoplasty and tonsillectomy were the most common procedures reported in all 3 years. In contrast, 63%, 71%, and 83% reported resident surgical competency for hypopharyngeal procedures in 2000, 2005, and 2010. Lingual tonsillectomy was the most common procedure in all 3 years. CONCLUSION: Surgical practice patterns in the United States do not reflect current practice recommendations for treatment of OSA, which emphasize multilevel surgery. Limited surgical residency training in hypopharyngeal procedures may be a contributing factor, although there appears to be an increasing trend in resident competency. Improvement in the scope of resident surgical training for treatment of OSA may lead to improved surgical outcomes. LEVEL OF EVIDENCE: 3b.
OBJECTIVES/HYPOTHESIS: Most patients with obstructive sleep apnea (OSA) have multilevel obstruction. Improved outcomes with multilevel surgery compared to isolated palatal surgery have been well documented. Despite this, surgical practice patterns in the United States have been slow to change. The purpose of this study was to evaluate whether current practice patterns are a reflection of limited surgical residency training in hypopharyngeal procedures. STUDY DESIGN: Cross-sectional Internet survey. METHODS: Program directors from 103 accredited U.S. otolaryngology residency programs were surveyed regarding past (2000, 2005) and more recent (2010) resident surgical competency in operative techniques for treatment of OSA. RESULTS: Of the 48 survey respondents, 85%, 90%, and 100% reported resident surgical competency for oropharyngeal procedures in 2000, 2005, and 2010, respectively. Uvulopalatopharyngoplasty and tonsillectomy were the most common procedures reported in all 3 years. In contrast, 63%, 71%, and 83% reported resident surgical competency for hypopharyngeal procedures in 2000, 2005, and 2010. Lingual tonsillectomy was the most common procedure in all 3 years. CONCLUSION: Surgical practice patterns in the United States do not reflect current practice recommendations for treatment of OSA, which emphasize multilevel surgery. Limited surgical residency training in hypopharyngeal procedures may be a contributing factor, although there appears to be an increasing trend in resident competency. Improvement in the scope of resident surgical training for treatment of OSA may lead to improved surgical outcomes. LEVEL OF EVIDENCE: 3b.
Authors: Giovanni Cammaroto; Giulia Bianchi; Henry Zhang; Vik Veer; Bhik Kotecha; Ofer Jacobowitz; Marina Carrasco Llatas; Paula Martínez Ruiz de Apodaca; Rodolfo Lugo; Giuseppe Meccariello; Giannicola Iannella; Riccardo Gobbi; Song Tar Toh; Ying-Shuo Hsu; Ahmed Yassin Baghat; Jerome R Lechien; Christian Calvo-Henriquez; Carlos Chiesa-Estomba; Maria Rosaria Barillari; Badr Ibrahim; Tareck Ayad; Nicolas Fakhry; Paul Hoff; Eric Rodrigues Thuler; Lyndon Chan; Chloe Kastoer; Madeline Ravesloot; Andrea De Vito; Filippo Montevecchi; Claudio Vicini Journal: Sleep Breath Date: 2020-11-20 Impact factor: 2.816