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The surgical learning curve for implantation of an upper airway stimulator for selective hypoglossal nerve stimulation
Background An increasing number of facilities offer selective upper airway stimulation (Inspire Medical Systems, USA) with different levels of experience. The aim of the study was to investigate whether there is a surgical learning curve in terms of surgical and sleep parameter outcomes.
Patients & methods For this purpose, data from the international multicentric registry study (ADHERE) were examined. Centers with more than 20 implantations and at least 6-month follow-up results were included. The results of the first ten implantations (group 1) were compared with the following ten implantations (group 2).
Results 13 centers with a total of 260 patients could be included. Age, gender, BMI, preoperative apnea-hypopnea index (AHI) and Epworth sleepiness scale (ESS) did not differ between the two groups. The complication rate was not different between the groups. The mean surgical time decreased from 2.6 ± 0.6 hours (Group 1) to 2.3 ± 0.7 hours (Group 2) (p = 0.002). The decrease in AHI from baseline to follow-up was similar between the two groups (-24.6 ± 18.1 vs. -24.0 ± 17.8 events / hour, p = 0.80). Same effects was seen in the ESS decrease (-2.8 ± 4.6 versus -3.3 ± 4.9, p = 0.49). The AHI and ESS results remained constant over a 12-month period.
Conclusions Despite a reduction in average surgery time, no changes in AHI or ESS over the first twenty implantations could be detected as a learning curve effect. Further inclusion of centers in the ADHERE registry will show whether the high quality and high standard of care remains constant.
ADHERE Register der Firma Inspire Medical Systems
Article published online:
10 June 2020
© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).
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