Sleep Apnea Increases Ninety-Day Complications and Cost Following Primary Total Joint Arthroplasty

Abstract Background Sleep apnea (SA) negatively affects bone mineralization, cognition, and immunity. There is paucity in the literature regarding the impact of SA on total joint arthroplasty (TJA). The purpose of this study was to compare complications in patients with and without SA undergoing either total knee (TKA) or total hip arthroplasty (THA). Methods A retrospective review from 2005 – 2014 was conducted using the Medicare Standard Analytical Files. Patients with and without SA on the day of the primary TJA were queried using the International Classification of Disease, ninth revision (ICD-9) codes. Patients were matched by age, gender, Charlson-Comorbidity Index (CCI), and body mass index (BMI). Patients were followed for 2 years after their surgery. 90-day medical complications, complications related to implant, readmission rates, length of stay (LOS), and 1-year mortality were quantified and compared. Logistic-regression was used to calculate odds-ratios (OR) with their respective 95% confidence interval (95%CI) and p- values. Results After the random matching process there were 529,240 patients (female = 271,656, male = 252,106, unknown = 5,478) with (TKA = 189,968; THA = 74,652) and without (TKA = 189,968; THA = 74,652) SA who underwent primary TJA between 2005 – 2014. Patients with SA had greater odds of developing medical complications following TKA (OR: 3.71) or THA (OR: 2.48). Conclusion The study illustrates an increased risk of developing postoperative complications in patients with SA following primary TJA. Surgeons should educate patients on these adverse effects and encourage the use of continuous positive airway pressure which has been shown to mitigate many postoperative complications.