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J Arthroplasty. 2017 Sep;32(9):2680-2683. doi: 10.1016/j.arth.2017.04.040. Epub 2017 Apr 27.

Perioperative Complications in Patients With Sleep Apnea Undergoing Total Joint Arthroplasty.

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Department of Internal Medicine, Pennsylvania Hospital of the University of Pennsylvania Health System, Philadelphia, Pennsylvania.
Department of Orthopaedic Surgery, Rothman Institute of Orthopaedics, Thomas Jefferson University, Philadelphia, Pennsylvania.
Department of Anesthesiology, Thomas Jefferson University, Philadelphia, Pennsylvania.
Department of Anesthesiology, Thomas Jefferson University, Philadelphia, Pennsylvania; Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran.



This study aims to evaluate the effect of sleep apnea (SA) on perioperative complications after total joint arthroplasty (TJA) and whether the type of anesthesia influences these complications.


Using the ninth and tenth revisions of the International Classification of Diseases, coding systems, we queried our institutional TJA database from January 2005 to June 2016 to identify patients with SA who underwent TJA. These patients were matched in a 1:3 ratio based on age, gender, type of surgery, and comorbidities to patients who underwent TJA but were not coded for SA. Perioperative complications were identified using the same coding systems. Multivariate analysis was used to test if SA is an independent predictor of perioperative complications and if type of anesthesia can affect these complications.


A total of 1246 patients with SA were matched to 3738 patients without SA. Pulmonary complications occurred more frequently in patients with SA (1.7% vs 0.6%; P < .001), confirmed using multivariate analysis (odds ratio = 2.91; 95% confidence interval, 1.58-5.36; P = .001). Use of general anesthesia increased risk of all but central nervous system complications and mortality (odds ratio = 15.88; 95% confidence interval, 3.93-64.07; P < .001) regardless of SA status compared with regional anesthesia. Rates of pulmonary and gastrointestinal complications, acute anemia, and mortality were lower in SA patients when regional anesthesia was used (P < .05).


SA increases risk of postoperative pulmonary complications. The use of regional anesthesia may reduce risk of pulmonary complications and mortality in SA patients undergoing TJA.


joint arthroplasty; morbidity; mortality; regional anesthesia; sleep apnea

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