Obstructive Sleep Apnea as a Risk Factor for Postoperative Complications after Shoulder Arthroplasty

OBJECTIVES: Obstructive sleep apnea has been identified as an important risk factor in perioperative orthopaedic surgery outcomes despite limited evidence in specific domains. Our objective was to determine if patients with obstructive sleep apnea 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 database to analyze 22,988 patients undergoing TSA or hemiarthroplasty between 2006-2008. Of these patients 1,983 (5.9%) had a concomitant diagnosis of OSA. Multivariate analysis with logistic regression modeling was used to compare patients with and without OSA for various outcomes and in hospital complications (pneumonia, DVT, PE, wound complications, hematoma, seroma, anemia). RESULTS: Patients with obstructive sleep apnea did not have overall increased in-hospital mortality and complications including Pulmonary Embolism (odds radio 1.083; p<0.01; and 1.038 respectively) compared to those without OSA. OSA was not associated with increased postoperative charges (odds ratio 1.01) but did increase length of stay (odds ratio 1.07; p<0.0001). CONCLUSION: OSA does not appear to be associated with increased in-hospital mortality or morbidity. It may however be associated with increased length of stay. Our study is the first to demonstrate that the association of OSA with surgical morbidity and mortality may not be applicable in shoulder arthroplasty. Further research is warranted to attempt to allocate resources and keep patient screening costs down, while optimizing patient outcomes.