The Effect of Obstructive Sleep Apnea on Venous Thromboembolism Risk in Patients Undergoing Total Joint Arthroplasty

Abstract

Introduction: Obstructive sleep apnea (OSA) is a known risk factor for venous thromboembolism (VTE), defined as pulmonary embolism (PE) or deep vein thrombosis (DVT); however, little is known about its effect on VTE rates after total joint arthroplasty (TJA). This study sought to determine whether patients with OSA who undergo TJA are at greater risk for developing VTE versus those without OSA. Methods: A retrospective analysis was conducted on 12,963 consecutive primary TJA patients at a single institution from 2016 to 2019. Patient demographic data were collected through query of the electronic medical record, and patients with a previous history of OSA and VTE within a 90-day postoperative period were captured using the International Classification of Disease, 10th revision diagnosis and procedure codes. Results: Nine hundred thirty-five patients with OSA were identified. PE (0.6% versus 0.24%, P = 0.023) and DVT (0.1% versus 0.04%, P = 0.37) rates were greater for patients with OSA. A multivariate logistic regression revealed that patients with OSA had a higher odds of PE (odds ratio [OR] 3.821, P = 0.023), but not DVT (OR 1.971, P = 0.563) when accounting for significant demographic differences. Female sex and total knee arthroplasty were also associated with a higher odds of PE (OR 3.453 for sex, P = 0.05; OR 3.243 for surgery type, P = 0.041), but not DVT (OR 2.042 for sex, P = 0.534; OR 1.941 for surgery type, P = 0.565). Conclusion: Female patients with OSA may be at greater risk for VTE, specifically PE, after total knee arthroplasty. More attention toward screening procedures, perioperative monitoring protocols, and VTE prophylaxis may be warranted in populations at risk.