Short-Term Risk of Complications Related to Obstructive Sleep Apnea After Sinonasal Surgery

Nrusheel Kattar; Dylan A. Levy; Edward D. McCoul; Nrusheel Kattar; Dylan A. Levy

doi:10.31486/toj.25.0013

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Short-Term Risk of Complications Related to Obstructive Sleep Apnea After Sinonasal Surgery

Nrusheel Kattar, Dylan A. Levy, Edward D. McCoul, Nrusheel Kattar, Dylan A. Levy, Edward D. McCoul

Ochsner Clinic Foundation (2025)

Empirical-ClinicalObservational-CohortPDF AvailableGrade Eligible⚠️ Moderate Risk Flags

Overall Assessment

Weak Methodological Quality

Assessment created by PaperScores Medical AI v0 on Dec 14, 2025

D-

38/100

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Quality Dimensions

Bias & Integrity

COI handling, outcome switching, selective reporting

C-55

Methods Rigour

Protocol clarity, sampling, controls

D-35

External Validity

Generalisability, setting, population

C60

Transparency & Reproducibility

Data/code/materials availability, preregistration

F10

Significance & Novelty

Contribution vs prior art; context if known

C-55

Statistical Validity

Models, assumptions, multiplicity, CI priority

D-30

Integrity & Transparency

Integrity checks

P-hacking risk?

?

Review recommended

Signs of selective hypothesis testing or analysis choices that could inflate false positive rates.

Outcome switching?

?

Review recommended

Evidence that primary outcomes were changed during or after the study, potentially distorting results.

Conflict of interest?

?

None suspected

Authors have financial or other relationships that could bias research findings.

Data integrity issues?

?

None suspected

Concerns about the accuracy, completeness, or authenticity of the reported data.

Open science signals

Research data

?

Not shared

Raw data used in the analyses is publicly available or accessible upon request.

Analysis code

?

Not shared

Code or scripts used to analyze the data are shared for reproducibility.

Study materials

?

Not applicable

Protocols, questionnaires, and other materials are publicly available.

Premise

Primary Research Question

Do adults with preoperative OSA have higher short-term complications after sinonasal (and other) surgeries vs non-OSA?

Hypothesis

OSA patients undergoing sinonasal surgery have higher unplanned admissions and respiratory complications.

Hypothesis is Falsifiable

✓Yes

Specified outcomes with thresholds (eg desaturation <92%) and comparisons.

PICO Framework

Population✓Yes

Adults ≥18 outpatient surgeries 2013–2020; exclusions noted.

Intervention✓Yes

Exposure=preoperative OSA; index procedure types defined.

Comparison✓Yes

OSA vs non-OSA within surgery types; pooled via Mantel–Haenszel.

Outcome✓Yes

Unplanned admission, desaturation<92%, supplemental O2, 30-day readmission.

Literature Positioning

Literature Review Balanced

Well covered

Contextualised with prior OSA perioperative risk and nasal surgery literature.

Evidence: References 1–25

Research Gap Clearly Stated

Well covered

States paucity of evidence on immediate postop outcomes across ENT surgeries.

Evidence: Discussion, p.5

Stated Contribution Clear

Well covered

Quantifies short-term risks by surgery type; first comparative analysis claimed.

Evidence: Discussion, p.5

Study Provenance

Peer reviewed venueFunding not reportedConflicts disclosed4 affiliations listed

Authors & Affiliations

LSU Health Shreveport; Tulane University; Ochsner Clinic Foundation; The University of Queensland Ochsner Clinical School.

Funding Statement

Not reported

Conflicts of Interest

Dr McCoul is a consultant for 3D Matrix, Advanced Rx, Optinose, Sanofi, Stryker, Zsquare; others nothing to disclose.

Peer Review

✓Ochsner Journal Original Research article with DOI.

Evidence: front matter

Methodological Assessment

Observational StudySTROBEObservational

9 applicable checklist items.

Yes 4 · No 3 · Unclear 2

Study Design & Definitions

✓

Participant Selection Described

Cohort selection detailed: adults outpatient; timeframe 2013–2020; exclusions listed.

Evidence: Methods—Participants, p.2

✓

Variable Definitions Clear

Outcomes defined incl. desaturation <92%, unplanned admission same encounter.

Evidence: Methods—Variables, p.2

✗

Confounding Addressed

No multivariable adjustment/matching; baseline imbalances present.

Evidence: Limitations, p.6; Table 1

✓

Temporality Established

Exposure pre-op OSA; outcomes postoperative/30-day.

Evidence: Methods—Variables, p.2

✓

Exposure Definition Anchored

OSA defined preoperatively; outcomes anchored to index surgery encounter.

Evidence: Methods—Variables, p.2

Bias Mitigation

✗

Balance Diagnostics Acceptable

No balance diagnostics/matching; age/sex differ by OSA status.

Evidence: Table 1

?

Selection Bias Addressed

No explicit assessment; retrospective EHR from one system.

Evidence: Methods—Participants, p.2

?

Misclassification Assessed

Undiagnosed OSA in non-OSA group acknowledged but not quantified.

Evidence: Limitations, p.6

Robustness

✗

Negative Controls or E-value

No negative controls or E-values reported.

Evidence: Statistical Methods/Results

Modules without applicable checklist items (8)

These designs were fully marked as not applicable but remain available for reference.

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Study Overview

Study Design

Observational Cohort

Primary classification used to evaluate this research.

Population

Adults ≥18 undergoing outpatient sinonasal, oropharyngeal, laryngeal, otologic, rotator cuff, or inguinal hernia surgery at a tertiary system (SE USA), 2013–2020.

Brief summary of who or what was studied.

Sample Size

17,373

Number of participants included in the study analyses.

Study Arms

12 arms

Total number of intervention or comparison groups.

Pre-registration

Not registered

Indicates whether the protocol or trial was registered before data collection.

Follow-up

Immediate PACU/day-of-surgery; 30-day readmission.

Duration of observation or follow-up for outcomes.

Primary Outcome

Primary outcome was not pre-specified.

Effect Size

RR: RR 3.12 (95% CI 2.07–4.70) for unplanned admission after sinonasal surgery (OSA vs non-OSA)

Reviewer Notes

Retrospective cohort from EHR; exposure=preop OSA vs non-OSA; outcomes per surgical encounter; no randomisation/adjustment.

Publication Details

DOI

10.31486/toj.25.0013

Published

November 19, 2025

Citations

0 citations

External Resources

DOI Link OpenAlex

Disclaimer: This assessment is generated by AI and should not be the sole basis for clinical or research decisions. Always review the original paper and consult with domain experts.

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