title: Obstructive sleep apnea as a risk factor after shoulder arthroplasty.
abstract: BACKGROUND
  Obstructive sleep apnea (OSA) has been identified as an important risk factor in perioperative orthopaedic surgery outcomes despite limited evidence. Screening systems are being instituted in increasing frequency to prevent morbidity and mortality. Our objective was to determine if patients with OSA have a higher likelihood of postoperative in-hospital complications, length of stay, or increased costs after shoulder arthroplasty.
  
  
  METHODS
  We utilized the Nationwide Inpatient Sample (NIS) to analyze 22988 patients undergoing TSA or hemiarthroplasty. Of these patients, 1983 (5.9%) were diagnosed with OSA. Multivariate analysis with logistic regression modeling was used to compare patients with and without OSA for various outcomes.
  
  
  RESULTS
  Patients with obstructive sleep apnea had overall similar in-hospital mortality and complications including PE compared with those without OSA. OSA was not associated with increased postoperative charges ($39,741 in patients with OSA vs. $39,334 in those without OSA) and resulted in a shorter length of stay (mean, 2.61 vs. 2.91 days; P < .0001).
  
  
  CONCLUSIONS
  This study does not support OSA as a significant risk factor for in-hospital morbidity and mortality following shoulder arthroplasty. Our results suggest that a diagnosis of OSA does not increase perioperative morbidity and mortality including perioperative complications. Given the results of this study, further research is warranted to attempt to keep patient screening costs down while optimizing outcomes.
authors.affiliation: Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, VA, USA.
authors.forename: Justin W
authors.initials: JW
authors.lastname: Griffin
authors.forename: Wendy M
authors.initials: WM
authors.lastname: Novicoff
authors.forename: James A
authors.initials: JA
authors.lastname: Browne
authors.forename: Stephen F
authors.initials: SF
authors.lastname: Brockmeier
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019643:Arthroplasty, Replacement / Q000009:adverse effects* / Q000191:economics; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007592:Joint Diseases / Q000453:epidemiology / Q000601:surgery*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000191:economics / Q000453:epidemiology; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012785:Shoulder Joint / Q000601:surgery; D020181:Sleep Apnea, Obstructive / Q000191:economics / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology
keywords: Level II; Prognostic Study; Retrospective Cohort Study; Shoulder arthroplasty; complications; cost analysis; length of stay; obstructive sleep apnea