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No Difference in 90-day Complication Rates Between Patients With and Without Obstructive Sleep Apnea Undergoing Total
Brooke Birbara1, Jordan A Bauer2, Alexander K Hahn2
1University of Connecticut, Storrs.
Orthopedics
|September 16, 2025
Summary
Obstructive sleep apnea (OSA) does not increase 90-day complications after total joint arthroplasty (TJA). Treated or untreated OSA showed no significant difference in complication risks for TJA patients.
Area of Science:
- Orthopedics
- Sleep Medicine
- Anesthesiology
Background:
- Obstructive sleep apnea (OSA) is a known comorbidity affecting total joint arthroplasty (TJA) patients.
- Limited research exists on propensity score matching for OSA in TJA and comparing treated vs. untreated OSA outcomes.
- This study investigates the risk of 90-day postoperative complications in TJA patients with treated and untreated OSA.
Purpose of the Study:
- To determine if obstructive sleep apnea (OSA) is an independent risk factor for 90-day postoperative complications in total joint arthroplasty (TJA).
- To compare complication rates between treated and untreated OSA patients undergoing TJA.
- To assess the impact of OSA comorbidities on TJA outcomes.
Main Methods:
- Retrospective analysis of 17,272 patient charts, with 3,876 diagnosed with OSA.
- Propensity score matching created a cohort of 7,014 patients (3,507 OSA, 3,507 non-OSA), matched on age, sex, BMI, ASA class, and surgery type.
- Patients were categorized into treated (CPAP use) and untreated OSA groups; chi-square and logistic regression analyses were performed.
Main Results:
- Obstructive sleep apnea (OSA) alone was not a significant predictor of 90-day postoperative complications in the propensity-matched TJA sample.
- Higher American Society of Anesthesiologists (ASA) class and Charlson Comorbidity Index (CCI) were significantly associated with increased complication rates.
- No significant difference in 90-day complication rates was observed between treated and untreated OSA patients (P=0.29).
Conclusions:
- Obstructive sleep apnea (OSA) is not independently associated with increased short-term postoperative complications following primary total joint arthroplasty (TJA) when using propensity score matching.
- Associated comorbidities, rather than OSA itself, may contribute to higher complication rates in TJA patients.
- Surgeons can be reassured that OSA alone is unlikely to be a major factor in short-term TJA outcomes.
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