The significance of better utilization of patients' preoperative information in predicting outcomes of velopharyngeal surgery: a prospective cohort study
The significance of better utilization of patients' preoperative information in predicting outcomes of velopharyngeal surgery: a prospective cohort study
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DOI：
10.5664/jcsm.9734
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发表时间：
2022-03-01
影响因子：
4.3
通讯作者：
Ye, Jingying
中科院分区：
文献类型：
--
作者：
Zhang, Junbo;Cao, Xin;Ye, Jingying
研究目的：比较包含通过体格检查、计算机断层扫描和多导睡眠图获得的 3 个独立预测因子的中医评分系统与仅包含体格检查变量的标准弗里德曼分期系统在预测接受腭咽手术的阻塞性睡眠呼吸暂停综合征患者的手术结果方面的效率。 方法：这项前瞻性研究在 265 名接受腭咽手术的阻塞性睡眠呼吸暂停综合征患者中进行。所有这些患者在手术后至少 3 个月均接受多导睡眠图重新检查，以评估手术结果。计算并比较2个系统的手术结果预测效果。结果：总有效率和治愈率分别为63.8%（169/265）和22.3%（59/265）。 Friedman I期患者32例，有效率和治愈率分别为81.3%（26/32）和28.1%（9/32）；中医评分<14分的患者70例，有效率和治愈率分别为91.4%（64/70）和42.9%（30/70）。 Friedman 分期和中医分级是唯一独立预测手术反应的 2 个因素（P < .05，比值比 = 0.642 和 0.382）。手术反应的受试者工作特征曲线分析显示，Friedman 分级的曲线下面积值为 0.600，显着低于 TCM 分级的 0.718（P = .005）。呼吸暂停低通气指数和中医分级是唯一独立预测手术治愈的两个因素（P < .05，比值比值= 0.981和0.465）。结论：与Friedman分期系统相比，中医评分系统在选择合适的腭咽手术候选人方面更有效。主要原因可能是它更好地利用了患者的术前信息，特别是生理因素的纳入。
Study Objectives: To compare the efficiency of a TCM scoring system that includes 3 independent predictors obtained by physical examination, computed tomography, and polysomnography with the standard Friedman staging system that includes only physical examination variables for predicting surgical outcomes in patients with obstructive sleep apnea syndrome who undergo velopharyngeal surgery.Methods: This prospective study was carried out in 265 patients with obstructive sleep apnea syndrome who underwent velopharyngeal surgery. All these patients were re-examined with polysomnography for evaluation of surgical outcomes at least 3 months after surgery. The efficacies in the surgical outcome prediction of 2 systems were calculated and compared.Results: The overall response rate and cure rate was 63.8% (169/265) and 22.3% (59/265), respectively. There were 32 patients with Friedman stage I, with a response rate and cure rate of 81.3% (26/32) and 28.1% (9/32), respectively, and 70 patients with TCM scores of < 14 with a response rate and cure rate of 91.4% (64/70) and 42.9% (30/70), respectively. Friedman stage and TCM grade were the only 2 factors independently predictive of surgical response (P < .05, odds ratio value = 0.642 and 0.382). The receiver operating characteristic curve analysis for surgical response showed that the area under the curve value was 0.600 for Friedman stage, which was significantly lower than that for TCM grade, 0.718 (P = .005). Apnea-hypopnea index and TCM grade were the only 2 factors independently predictive of surgical cure (P < .05, odds ratio value = 0.981 and 0.465).Conclusions: Compared with the Friedman staging system, the TCM scoring system was more efficient in selecting proper candidates for velopharyngeal surgery. The main reason may be its better utilization of patients' preoperative information, especially the inclusion of physiological factors.