Open AccessFriedman Staging for Sleep Surgery: Meta‐analysis
Author(s) -
Friedman Michael,
Hamilton Craig S.,
Samuelson Christian G.
Publication year - 2012
Publication title -
otolaryngology–head and neck surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.232
H-Index - 121
eISSN - 1097-6817
pISSN - 0194-5998
DOI - 10.1177/0194599812451438a270
Subject(s) - meta analysis , medicine , publication bias , medline , surgery , political science , law
Objective 1) Review the available literature reporting on the success of single and multi‐level sleep surgery in relation to Friedman Anatomical Staging (FAS). 2) Combine statistical outcomes of multiple studies (where appropriate) to determine surgical success rates (defined by postoperative apnea‐hypopnea index [AHI] <20 and 50% reduction) for each clinical stage. Method PubMed, MEDLINE, and Cochrane Trial Registry (through 12/2011) were searched, combined with manual review of relevant article bibliographies. All studies were assessed by 3 reviewers. Systematic review and random‐effects meta‐analysis of studies assessing the success of sleep surgery in relation to FAS were performed. Outcomes are reported as proportional success rates. Results Six studies met inclusion criteria and had data suitable for pooling (521 patients). Success rate (SR) for single‐level palatal surgery with FAS‐1 was. 806 (.630,. 910; P =. 002). Multi‐level surgical data for FAS‐1 yielded SR. 706 (.458,. 872; P =. 1). Single‐level surgery for FAS‐2 yielded SR. 379 (.224,. 564; P =. 197). Multi‐level surgical data for FAS‐2 yields SR. 647 (.527,. 751; P =. 017). Single‐level surgery for FAS‐3 yields SR. 081 (.037,. 169; P <. 001). Multi‐level surgery for FAS‐3 yields SR. 412 (.254,. 591; P =. 334). Analysis of publication bias yielded non‐significant Egger’s regression intercepts for studies reporting FAS‐2/3 success. Too few studies reported FAS‐1 success to allow statistical analysis of publication bias. Conclusion These findings demonstrate the utility of FAS in predicting the success of OSA surgery. Findings further reinforce the value of OSA surgery in patients with FAS‐1 regardless of disease severity. In addition, they add to the evidence that multi‐level surgery is often necessary to treat patients with more advanced staging.