A Nationwide Comparison of Pharyngeal and Jaw Surgery for Sleep Apnea: Socioeconomic Differences and Complications

Maxillomandibular jaw advancement surgery is the most effective surgical intervention beyond tracheotomy for patients with severe obstructive sleep apnea, while pharyngeal procedures have been less effective (1). The aims of this study were to 1) identify socioeconomic differences between adult patients receiving pharyngeal and jaw procedures for sleep apnea, and 2) determine differences in complications.

All patients, age 14 or older, with a primary hospital diagnosis of sleep apnea were identified using the Nationwide Inpatient Sample database obtained through the Healthcare Cost and Utilization Project from 2005-2012.  ICD9 codes were used to determine if a pharyngeal or jaw procedure was performed. Patient demographics, comorbidities and complications were compared. Chi squared and Student's t-test were used for analysis.

Among 6,297 sleep surgeries performed, 5,945 (94.4%) were pharyngeal and 352 (5.6%) were jaw procedures. The average age of patients undergoing pharyngeal surgery was 43.7 compared to 44.8 for patients undergoing jaw surgery (p=0.068). Although men were more commonly hospitalized for sleep apnea than women (65.6 v. 34.6%, p<0.0001), 6.8% of women underwent jaw surgery compared to 5.2% of men (p=0.02). Caucasian patients accounted for 67.4% of pharyngeal and 87.6% of jaw procedures, while non-Caucasians accounted for 32.6% of pharyngeal and 12.4% of jaw procedures (p<0.0001). Further analysis of race revealed that jaw surgery comprised 7.2% of procedures among Caucasians, compared to 1.4% among African Americans (p<0.0001), 2.8% among Hispanics (p<0.0001), and 3.2% among Asians (p=0.046). Patients undergoing jaw surgery were more likely to have private insurance or self pay (91.6%) than patients undergoing pharyngeal surgery (81.2%, <0.0001). Patients undergoing pharyngeal surgery had a higher obesity rate than patients undergoing jaw procedures (21.4 v. 14.2%, p=0.003), but otherwise there was no difference in comorbidities. There was no significant difference in bleeding, infection, or cardiopulmonary complications, which were less than or equal to 1.3% (p>0.05).

Jaw surgery accounts for a minority of sleep procedures, even though it is often more effective and there is no difference in overall complication rates compared to pharyngeal procedures. Non-Caucasians receive less jaw surgery than Caucasian patients, even though certain groups including Asians and Hispanics may be more prone to craniofacial skeletal deficiencies (2). Awareness of socioeconomic differences in access to surgery may help guide future initiatives to improve surgical management of sleep apnea.