No Difference in 90-day Complication Rates Between Patients With and Without Obstructive Sleep Apnea Undergoing Total Joint Arthroplasty.

Background: Obstructive sleep apnea (OSA) has shown significant effects on complication rates in total joint arthroplasty (TJA) patients. Current research lacks appropriate propensity score matching of this comorbidity as well as data surrounding treated OSA compared to untreated OSA among TJA patients. This study examined if patients with treated and untreated OSA were at higher risk for 90-day postoperative complications following TJA.

Materials and methods: 17,272 patient charts were retrospectively examined, with 3,876 having OSA and 13,396 not. Following propensity score matching of 7,014 patients, 3,507 were identified to have OSA and 3,507 not. Patients were matched based on age, sex, body mass index, American Society of Anesthesiologists (ASA) class, and type of surgery, then further divided into untreated versus treated OSA based on continuous positive airway pressure use. Chi-square analyses compared patient characteristics, and a multivariable logistic regression model assessed the effect of OSA on 90-day complication rates.

Results: OSA alone was not an indicator for 90-day postoperative complications in our propensity-matched sample. Higher ASA classes (P<0.01) and higher Charlson Comorbidity Index (CCI; P<0.01) were associated with a significant increase in 90-day complication rates compared with patients with ASA classes I-II and lower CCI, respectively. There was no significant difference in complications between patients with untreated and treated OSA (P=0.29).

Conclusion: Using propensity score matching, this study indicates that OSA alone is not associated with an increased risk of 90-day postoperative complications in primary TJA. While associated comorbidities of OSA may contribute to increased complication rates, surgeons can be reassured that OSA alone may not be a significant factor in short-term postoperative outcomes.