An Operation Obsession
© Kerrin Leon White
This depicts an extreme example of what I run into often in my Internet dealings with apnea patients--what I call "an operation obsession."
This obsession strikes me as deserving an effort at understanding.
No deep analysis need be done to explain why surgeons who see sleep apnea patients encourage their leanings towards surgery: far and away, the most remunerative activity on which a surgeon can spend his time is performing surgery.
If it shocks you to read an allegation that a surgeon might sway a patient towards what pays him best and what the surgeon knows best how to do--I forgive you for your touching trust in doctors. As patients, we would all like to believe they have only our best interests in mind. However, as my friend points out, what do you expect when you ask a auto mechanic if your car could use a tune-up?
But on this occasion, I have more than a diatribe to offer you: I have some newly reported research findings to convey.
In a recent issue of the surgical journal, Otolaryngology--Head and Neck Surgery (September 1990) the surgeons themselves (Brent A. Senior, MD, Leon Rosenthal, MD, Aucia Lumley, MD, Rebecca Gerhardstein, BA, and Ryan Day, BS, of the estimable University of North Carolina at Chapel Hill) report data raising questions about the effectiveness of the most commonly used surgical procedure for apnea, the uvulopalatopharyngoplasty or UPPP, in mild cases, where some have suggested it most suitable.
In their own experience with 37 patients operated on during 1966 with a UPP with or without tonsillectomy and/or septoplasty, the authors had follow-up polysomnography results (regrettably absent from many reports of surgical outcome) in 68% of patients an average of 3 1/2 years after surgery, to compare with preoperative results. Of those patients, only 40% met the minimal criterion for surgical success of having at least a 50% reduction of their Respiratory Event Indices (the number of respiratory events per hour of sleep). In cases of mild apnea, such as studied here (with pretreatment indices averaging 14 and ranging from 6 to 23) a 50% reduction would result in most--but not all--patients ending up with indices below the threshold of diagnosis (variously, 5 or 10 in different studies).
