Patient-Reported Outcomes of Palatopharyngeal Surgery Without Tonsillectomy: A Meta-Analysis.
Samuel Tschopp, Flora Meinert, Georgios Mantokoudis et al.
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In 30 seconds
This systematic review and meta-analysis compared patient-reported outcomes after palatopharyngeal surgery without tonsillectomy in adults treated for snoring or obstructive sleep apnea. Across 55 studies involving 1815 patients, surgery was associated with a mean 3.3-point reduction in Epworth Sleepiness Scale scores (95% CI, 2.7 to 3.9) and a 4.1-point reduction in snoring intensity (95% CI, 3.7 to 4.6). Outcomes varied by technique; several approaches showed the largest reductions. The authors found no evidence that effectiveness declined with longer follow-up, although study heterogeneity was considerable and overall risk of bias was moderate.
Key findings
- Across 55 studies and 1815 patients, mean Epworth Sleepiness Scale scores fell by 3.3 points (95% CI, 2.7 to 3.9).
- Snoring intensity decreased by a mean of 4.1 points (95% CI, 3.7 to 4.6).
- Suture palatopharyngoplasty, muscle relocation, cold-steel techniques, and powered instruments showed the largest reductions in both outcomes.
- Meta-regression found no evidence of declining effectiveness with longer follow-up for either patient-reported outcome.
Why it matters
Patient-reported sleepiness and snoring are relevant outcomes when assessing surgery for snoring and obstructive sleep apnea. These pooled estimates suggest improvement after palatopharyngeal procedures performed without tonsillectomy, while variation by technique and considerable heterogeneity indicate that results should be interpreted in the context of the underlying studies.
What to keep in mind
Heterogeneity across studies was considerable, and the overall risk of bias was moderate.