title: Total Joint Arthroplasty in Patients with Obstructive Sleep Apnea: Strategies for Reduction of Perioperative Complications.
abstract: Obstructive sleep apnea (OSA) has been associated with increased risk for medical complications following total joint arthroplasty. Our institution employs postoperative precautions for OSA patients in an effort to minimize the impact of postoperative complications in this group. We performed this study to assess the effect of careful monitoring on postoperative complication rates in OSA patients. We identified patients with a clinically suspected or objective diagnosis of OSA who received total joint arthroplasty between January 1998 and January 2008. 1016 cases in 792 OSA patients were matched to 1016 cases in 993 control patients to compare complication rates. There were no differences between OSA and control patients in cardiovascular and respiratory complications following TJA. Patients with OSA experienced increased rates of postoperative acute renal failure when compared with controls (p = 0.02) and experienced mild desaturations (Hb O2 < 92%) (p = 0.002), but not severe desaturations (Hb O2 < 88%) (p = 0.2). We conclude that our postoperative monitoring protocols are successful in reducing postoperative complications most commonly associated with OSA. We were interested to note the increased risk for OSA patients to develop postoperative acute renal failure and believe that future study is warranted to explore the link between OSA and renal failure.
authors.affiliation: Arthroplasty Fellow, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
authors.forename: James
authors.initials: J
authors.lastname: Cashman
authors.affiliation: Research Fellow, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
authors.forename: Orhan
authors.initials: O
authors.lastname: Bican
authors.affiliation: Research Fellow, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
authors.forename: Ravi
authors.initials: R
authors.lastname: Patel
authors.affiliation: Research Fellow, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
authors.forename: Christina
authors.initials: C
authors.lastname: Jacovides
authors.affiliation: Research Fellow, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
authors.forename: Chelsea
authors.initials: C
authors.lastname: Dalsey
authors.affiliation: Professor Of Orthopedics, Rothman Institute of Orthopedics, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
authors.forename: Javad
authors.initials: J
authors.lastname: Parvizi