Hypoxemia following hospital discharge after fast‐track hip and knee arthroplasty – A prospective observational study subanalysis

Abstract

The study was supported by a grand from the Lundbeck Foundation, Hellerup Denmark. The foundation is independent of the pharmaceutical company Lundbeck and was not involved in designing or conducting the study. Background: Post-operative hypoxemia is prevalent in hospitalized patients and may adversely affect recovery. However, little data exist on the post-discharge phase or details on duration, severity and potential risk factors. Thus, we investigated the incidence and risk factors for severe desaturation during the first post-operative week after THA/TKA by continuous nocturnal oxygen saturation monitoring. Methods: The study was a secondary analysis of a prospective cohort study of 112 patients undergoing fast-track THA/TKA. Patients with known sleep apnoea were excluded. Oxygen saturation and heart rate were recorded by a wireless wrist-worn pulse oximeter 2 nights before and 7 nights after surgery. Data on demographics, opioid consumption and cognitive function were collected from medical charts, patient diaries and clinical testing respectively. The primary outcome was occurrence of severe desaturation defined as periods with saturation <85% lasting ≥10 minutes. Secondary outcomes included description of various saturation levels and relevant risk factors. Results: Severe oxygen desaturation occurred in 35% of the patients during the first post-operative week. Duration and severity of hypoxemic episodes increased after the first post-operative day. Pre-operative episodes of hypoxemia significantly increased the risk of post-operative hypoxemic events (OR 2.4-4.4, CI 0.4-46), while pre-and post-operative opioid use, age, gender, ASA classification, type of surgery or anaesthesia were significantly related to the development of post-operative hypoxemia. Conclusions: One third of the patients suffered from increased and prolonged episodes of severe nocturnal hypoxemia during the first week after THA/TKA discharge. Increased risk for severe hypoxemic episodes was related to pre-operative hypoxemia.

Risk factors for hypoxaemia following hip fracture surgery in elderly patients who recovered from COVID-19: a multicentre retrospective study

“…Lung lesions, post-traumatic pulmonary micro thromboembolism, fat embolism syndrome, and damage-associated molecular patterns may contribute to preoperative hypoxaemia ( 11 ). In this study, we found that preoperative hypoxaemia was an independent risk factor for postoperative hypoxaemia, which was consistent with the findings of Luna et al ( 30 ). In their study, preoperative hypoxaemia significantly increased the risk of postoperative hypoxaemic events during the first week in patients undergoing joint replacement.…”

“…In this study, we found that ASA classification III was an independent risk factor for postoperative hypoxaemia. Luna et al ( 30 ) reported that ASA classification had a significant correlation not only with the occurrence of postoperative hypoxemia but also with the occurrence of hypoxemia after discharge.…”

Postoperative awake prone position in geriatric patients with hip fractures: a protocol for a randomized controlled trial on the efficacy of postoperative prone position in reducing pulmonary complications and improving oxygenation

“…We choose to carry out APP treatment for the first three consecutive PODs to prevent PPCs for the following reasons: 1. The peak time for diagnosis of PPCs and hypoxemia occurred on POD 4 after hip fracture surgery in the elderly [ 10 , 55 ]. 2.…”