The impact of sleep apnea on primary reverse shoulder arthroplasty for the treatment of glenohumeral osteoarthritis.

Introduction: As the prevalence of sleep apnea (SA) increases nationwide, large sample sized studies following primary reverse shoulder arthroplasty (RSA) in SA patients are scarce. Therefore, this study evaluated whether SA is associated with 1) longer in-hospital lengths of stay (LOS) 2) readmissions 3) medical complications and 4) costs.

Methods: A retrospective nationwide Medicare analysis from 2005 to 2014 was performed. Inclusion criteria were patients with SA undergoing RSA for the treatment of glenohumeral osteoarthritis. Study group patients were 1:5 ratio matched to controls yielding 6241 patients in the study and 31,179 in the comparison cohort. Logistic regression was used to calculate odds-ratios (OR) for readmissions and complications. A p-value less than 0.004 was significant.

Results: SA patients had significantly longer in-hospital LOS compared to their counterparts (3-days versus 2-days, p < 0.0001), but similar rates of 90-day readmissions (7.98% vs. 6.54%; OR: 1.00, p = 0.907). Patients with SA had significantly greater incidence and odds of 90-day medical complications (13.36% vs. 7.29%; OR: 1.42, p < 0.0001) and significantly higher 90-day costs ($16,529.16 vs. $14,789.15, p < 0.0001).

Conclusion: Patients with SA undergoing primary RSA for the treatment of glenohumeral OA have longer in-hospital LOS, increased medical complications, and costs of care. Readmissions were not more common.

Level of evidence: III.