Obstructive sleep apnea may be associated with complications after TJA
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Key takeaways:
- Patients with obstructive sleep apnea had significant complications and delirium after total joint arthroplasty.
- Physicians may consider implementing preoperative sleep apnea screenings.
Published results showed obstructive sleep apnea had a significant association with overall complications, as well as pulmonary and thromboembolic complications, among patients after total joint arthroplasty.
“Obstructive sleep apnea is a highly prevalent comorbidity and is often underdiagnosed in the general population,” Graham S. Goh, MD, orthopedic surgery resident at Boston University Medical Center, told Healio. “The data presented in our study allows surgeons to adequately risk stratify patients scheduled for TJA.”
Goh, Terence L. Thomas, BS, and colleagues performed a systematic review and meta-analysis of seven studies that included 20,977 patients with or without obstructive sleep apnea who underwent TJA. Outcomes included overall postoperative complications, utilization of critical care, length of stay (LOS) and mortality.
Goh and colleagues found patients with obstructive sleep apnea had a fourfold increased odds of overall complications (OR = 4.23), pulmonary complications (OR = 4.31) and delirium (OR = 3.94) compared with patients without obstructive sleep apnea. They also noted patients with obstructive sleep apnea had a twofold increased odds of thromboembolic complications (OR = 1.92) compared with patients without obstructive sleep apnea.
Goh and colleagues noted three of four studies reported significantly longer LOS for patients with obstructive sleep apnea vs. those without obstructive sleep apnea. They found one study reported significantly increased rates of unplanned critical care transfers for patients with obstructive sleep apnea vs. those without obstructive sleep apnea.
“In the era of value-based care, perioperative optimization for predictable procedures such as TJA has taken the center stage at many health care systems,” Goh said. “This data should encourage surgeons to identify at-risk patients through a thorough review of systems or administration of sleep apnea-specific surveys such as the STOP-BANG (snoring, tired, observed, blood pressure, BMI greater than 35, age older than 50 years, neck size, sex) questionnaire,” he added.
“These patients should then be counselled on the potentially increased complication rate following TJA,” he said. “After which, prophylactic CPAP therapy could be prescribed preoperatively, since there is early data demonstrating that this could improve cardiac function and lower perioperative complication rates.”
Perspective
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Obstructive sleep apnea is the one significant risk factor for the increased need for overnight stay in outpatient arthroplasty, according to our research. The authors provide an excellent review of the available literature on the topic and accurately identify obstructive sleep apnea as an independent risk factor for several perioperative complications. With accurate screening and management, the risks can be mitigated to a point where obstructive sleep apnea is no longer a risk for major medical and surgical complications. This requires diligence on the part of the medical team with the patient’s primary care team, preoperative optimization and anesthesia.
While the authors of this study do acknowledge the heterogeneity of the studies in terms of treatment of obstructive sleep apnea with continuous positive airway pressure or other interventions, in our experience this treatment is vital to safe and successful outpatient arthroplasty.
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