The Use of Continuous Positive Airway Pressure for Patients With Obstructive Sleep Apnea is Associated With Early Medical and Surgery-Related Complications Following Total Knee Arthroplasty: A National Database Study

BACKGROUND: Obstructive sleep apnea (OSA) has been shown to increase the risk of complications following total knee arthroplasty (TKA) although prior studies were limited by their ability to stratify OSA patients by disease severity. The objective of this study was to determine the effect size of the use of continuous positive airway pressure (CPAP) on early medical and surgery-related complications following TKA among patients with OSA. METHODS: Patients with OSA who underwent primary TKA were identified using the PearlDiver Mariner database. Ninety-day incidences of medical complications and 1-year incidences of surgery-related complications as well as hospital utilization were evaluated for OSA patients who had used CPAP prior to TKA compared to those who did not. RESULTS: CPAP patients were at increased 90-day risk of emergency department presentation (odds ratio [OR] 1.61; P < .0001), hospital admission (OR 1.33; P < .001), ICU admission (OR 1.45, P < .0001), pulmonary embolism (OR 1.68, P < .0001), deep vein thrombosis (OR 1.31, P < .0001), transfusion (OR 1.89, P < .0001), pneumonia (OR 1.63, P < .0001), cerebrovascular accident (OR 1.92, P < .0001), myocardial infarction (OR 1.57, P = .0015), sepsis (OR 1.35, P = .0025), blood loss anemia (OR 1.67, P < .0001), acute kidney injury (OR 1.65, P < .0001), and urinary tract infection (OR 1.99, P < .0001), as well as increased 1-year risk of undergoing revision surgery (OR 1.14, P = .0028), compared to OSA patients not using CPAP. CONCLUSIONS: OSA patients on CPAP undergoing TKA have significantly increased complication rates compared to OSA patients not using CPAP. LEVEL OF EVIDENCE: III, Retrospective review.