# Safety of outpatient non-upper airway surgery for patients with obstructive sleep apnea in ambulatory surgical centers: A systematic review

## TL;DR

This review finds that patients with obstructive sleep apnea can safely have non-upper airway surgery in outpatient centers if properly managed.

## Contribution

The study provides evidence that OSA patients can safely undergo outpatient non-upper airway surgery in ASCs with proper selection and interventions.

## Key findings

- Severe complications were rare and mostly occurred within the first 4 hours post-surgery.
- Large-scale studies show OSA is a risk factor for unplanned admissions and 30-day complications.
- Proper selection and perioperative care allow OSA patients to safely undergo outpatient surgery.

## Abstract

The systematic review aims to determine the safety of conducting non-upper airway surgery in an ambulatory surgery center (ASC) for OSA patients.

A comprehensive search was conducted from MEDLINE, Embase, CENTRAL, and Scopus from inception through February 2023.

Studies including non-upper airway surgery done in ASC settings were identified. Risk of bias was assessed using the Murad Tool and Newcastle-Ottawa scale. Primary outcomes were 24 hour complications and unplanned admission rates.

From 9313 studies, 13 non-OSA studies with 31,200 OSA participants and 318,709 non-OSA participants were identified. Severe complications were rare and tended to occur within the first 4 hours of the postoperative period. While a majority of smaller scale studies found no significant difference in unplanned admissions, large scale studies with multivariate analysis find OSA to be an independent risk factor for unplanned admission and 30-day complications. However, large scale ASC studies have found that with proper selection and perioperative interventions, OSA patients can undergo outpatient surgery at ASCs safely.

OSA patients with mild or controlled comorbidities can safely undergo ambulatory non-OSA surgery in ASCs.

The protocol for this review was registered with the PROSPERO database (Registration number: CRD42023415162).