Systematic Review on the Safety of Outpatient Upper Airway Surgery for Obstructive Sleep Apnea Patients in Ambulatory Surgical Centers
Bibliographic record
Abstract
ImportanceThis systematic review determines that the patients with obstructive sleep apnea (OSA) can undergo upper airway surgery in ambulatory surgical centers (ASCs) safely and determines which patients with OSA are appropriate for this environment.ObjectiveThe systematic review aimed to determine the safety of conducting upper airway surgeries on patients with OSA in ASCs.DesignThe Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed to perform a systematic review on ambulatory upper airway surgery studies. A comprehensive search was conducted from MEDLINE, Embase, CENTRAL, and Scopus from inception through February 2024. A descriptive analysis was conducted. Risk of bias was assessed using the Murad Tool and the Newcastle-Ottawa Scale.SettingHospital outpatient department or ambulatory surgical center.ParticipantsAdult patients with OSA.InterventionUpper airway surgery.Main Outcome MeasuresUnplanned admission rates and 24 hour complications.ResultsFrom 9313 studies, 11 upper airway surgery studies with 5714 participants were identified. Studies observed a 5.4% admission rate for medical reasons, predominantly stemming from avoidable admissions for desaturations. There was a 9.2% 24 hour complication rate. By initiating an oxygen discontinuation trial, OSA patients with controlled comorbidities can confidently proceed with OSA surgery at ASCs feasibly and safely. Patient selection is paramount in the ASC environment, with a focus on age, body mass index, apnea-hypopnea index, and controlled comorbidities.Conclusions and RelevanceOSA patients with mild or controlled comorbidities can safely undergo ambulatory OSA surgery in ASCs without sacrificing the cost-effectiveness of the ASC model. Future studies should use larger populations and prospective study designs.OtherThe protocol for this review was registered with the PROSPERO database (registration number: CRD42023415162).
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.015 | 0.085 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.011 | 0.013 |
| Bibliometrics | 0.007 | 0.007 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.005 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".