(1326) Healthcare Utilization and Outcomes Following Septoplasty in Adults with Obstructive Sleep Apnea and Deviated Septum

Introduction: Studies suggest isolated septoplasty for nasal septal deviation (NSD) has mixed effects on obstructive sleep apnea (OSA) severity, but its impact on long-term healthcare utilization and outcomes remains unclear. We studied the association of septoplasty with sleep-related utilization and clinical outcomes in adults with OSA and NSD.

Methods: In this retrospective cohort study, adults ≥ 18 years with NSD and OSA over a 20-year period were identified in TriNetX and stratified by septoplasty status. Septoplasty patients were compared with nonoperative controls using 1:1 propensity score matching on demographics and baseline comorbidities. The index event was the first qualifying NSD and OSA diagnosis, with outcomes assessed up to 5 years post index. Outcome-naive analyses were used for sleep-related and cardiopulmonary outcomes. Healthcare utilization was evaluated within postoperative windows (0-30 and 31-365 days). All-cause mortality was analyzed using time-to-event methods. A sensitivity analysis restricted to patients with baseline healthcare utilization was performed to assess healthy-user bias.

Results: After matching, 39,253 septoplasty patients were compared with 39,253 controls. Baseline CPAP use was similar between cohorts (2.8% vs 2.7%). Over 5 years, septoplasty patients had lower polysomnography use and new CPAP initiation (2.5% vs 3.4%, RR 0.88, 95% CI 0.81-0.96), alongside higher rates of palatopharyngoplasty (1.3% vs 0.6%, RR 2.23, 95% CI 1.91-2.60). Emergency department utilization was elevated at 0-30 days (RR 4.18, 95% CI 3.50-4.99) and 31-365 days (RR 1.11, 95% CI 1.02-1.20), while inpatient admission did not differ. Septoplasty was associated with lower 5-year risks of cardiopulmonary events and all-cause mortality (1.3 vs 1.9% HR 0.69, 95% CI 0.61-0.76). Results were consistent on sensitivity analysis.

Conclusions: In adults with NSD and OSA, septoplasty was associated with lower long-term cardiopulmonary risk and mortality, with reduced diagnostic testing and CPAP initiation despite increased surgery, suggesting distinct care trajectories by surgical selection.