Perioperative Complications in Patients With Sleep Apnea Undergoing Total Joint Arthroplasty

Naqvi, Syed Yaseen; Rabiei, Amin H.; Maltenfort, Mitchell; Restrepo, Camilo; Viscusi, Eugene R.; Parvızı, Javad; Rasouli, Mohammad R.

doi:10.1016/j.arth.2017.04.040

Cited by 29 publications

(17 citation statements)

References 21 publications

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“…Subsequent studies 236 , 239 confirmed the previous findings, while 1 suggested benefits with regard to mortality. 239 Notably, in a prospective analysis investigating drivers of postoperative worsening of sleep-disordered breathing, Chung et al 79 demonstrated that the utilization of general anesthesia was associated with an increased central apnea index postoperatively, while 72-hour total opioid dose was a driver of increased AHI. This finding suggests that the residual effects of general anesthesia may affect postoperative sleep architecture and sleep-disordered breathing in OSA.…”

Section: Anesthesia Techniquesupporting

confidence: 66%

“…With regard to comparative effectiveness between general and regional anesthesia specifically in patients with OSA, 6 observational studies were identified. 61 , 235 – 239 A summary of evidence is provided in Supplemental Digital Content, Table A12, http://links.lww.com/AA/C373 . Overall, studies indicated that the utilization of regional as opposed to general anesthesia would improve postoperative outcome.…”

Section: Anesthesia Techniquementioning

confidence: 99%

“…Overall, studies indicated that the utilization of regional as opposed to general anesthesia would improve postoperative outcome. 79 , 235 – 239 The largest population-based analysis included >30,000 patients with OSA from >400 US hospitals undergoing joint arthroplasty procedures. 235 Adjusted risk of numerous major complications was significantly lower in patients with OSA who received neuraxial anesthesia versus general anesthesia.…”

Section: Anesthesia Techniquementioning

confidence: 99%

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Society of Anesthesia and Sleep Medicine Guideline on Intraoperative Management of Adult Patients With Obstructive Sleep Apnea

Memtsoudis

Cozowicz

Nagappa

et al. 2018

Anesthesia &Amp; Analgesia

137

158

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The purpose of the Society of Anesthesia and Sleep Medicine Guideline on Intraoperative Management of Adult Patients With Obstructive Sleep Apnea (OSA) is to present recommendations based on current scientific evidence. This guideline seeks to address questions regarding the intraoperative care of patients with OSA, including airway management, anesthetic drug and agent effects, and choice of anesthesia type. Given the paucity of high-quality studies with regard to study design and execution in this perioperative field, recommendations were to a large part developed by subject-matter experts through consensus processes, taking into account the current scientific knowledge base and quality of evidence. This guideline may not be suitable for all clinical settings and patients and is not intended to define standards of care or absolute requirements for patient care; thus, assessment of appropriateness should be made on an individualized basis. Adherence to this guideline cannot guarantee successful outcomes, but recommendations should rather aid health care professionals and institutions to formulate plans and develop protocols for the improvement of the perioperative care of patients with OSA, considering patient-related factors, interventions, and resource availability. Given the groundwork of a comprehensive systematic literature review, these recommendations reflect the current state of knowledge and its interpretation by a group of experts at the time of publication. While periodic reevaluations of literature are needed, novel scientific evidence between updates should be taken into account. Deviations in practice from the guideline may be justifiable and should not be interpreted as a basis for claims of negligence.

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Section: Anesthesia Techniquesupporting

confidence: 66%

Section: Anesthesia Techniquementioning

confidence: 99%

Section: Anesthesia Techniquementioning

confidence: 99%

See 1 more Smart Citation

Society of Anesthesia and Sleep Medicine Guideline on Intraoperative Management of Adult Patients With Obstructive Sleep Apnea

Memtsoudis

Cozowicz

Nagappa

et al. 2018

Anesthesia &Amp; Analgesia

137

158

View full text Add to dashboard Cite

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“…Identifying risk factors for adverse events in TJA has been a major topic of research in recent years. Among these factors are diabetes, heart failure, chronic obstructive pulmonary disease, renal insufficiency, lower extremity arterial calcification, epilepsy, malnutrition, hypothyroidism, obesity, chronic opioid use, young age, and sleep apnea [3] , [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] . This exhaustive list makes it difficult to guide reliable risk stratification processes.…”

Section: Introductionmentioning

confidence: 99%

Risk stratification in primary total joint arthroplasty: the current state of knowledge

et al. 2019

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Background As we transition to value-based care delivery models, risk stratification in total joint arthroplasty is more important than ever. The purpose of this study was to identify patients who would likely require higher level of care and may not be suitable for inclusion in bundled payment models. Methods The American College of Surgeons National Surgical Quality Improvement Program database was queried for all patients who underwent primary total joint arthroplasty between 2011 and 2012. Five types of adverse events were assessed: medical complications, surgical complications, readmission, reoperation, and mortality. Univariate and multivariate logistic regression analyses were performed using a large number of demographic and morbidity variables. Results A total of 14,185 patients were identified. The 30-day medical complication, surgical complication, readmission, reoperation, and mortality rates were 2.0%, 3.2%, 4.0%, 1.5%, and 0.2%, respectively. Among the different variables assessed, only the American Society of Anesthesiologists (ASA) physical classification system was a significant risk factor for most outcomes assessed. Peripheral vascular disease was the most significant risk factor for medical complications and reoperation (odds ratio, 2.73 and 3.23, respectively). Bleeding disorders were the most significant risk factor for readmission and mortality (odds ratio, 2.03 and 5.86, respectively). Conclusions ASA score is a more reliable risk stratification tool than Charlson Comorbidity Index, but it is not sufficient by itself. Patients with higher ASA scores combined with peripheral vascular disease and/or bleeding disorders are at especially high risk of developing postsurgical adverse events and may not be suitable for inclusion in bundled payment models. These data can be used to develop better risk stratification models that are critically needed.

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“…However, this is the first study investigating the impact of OSA on outcomes in a regional anesthesia setting, whereas in most other studies mainly general anesthesia was used. Theoretically, in a cohort of near universal neuraxial anesthesia use, minimal pulmonary risk differences between OSA groups are expected as neuraxial anesthesia is recommended by guidelines and has been shown to reduce perioperative pulmonary complications in patients with OSA 12. However, the increased risk found in our study may indicate that the diagnosis of OSA itself increases the risk of pulmonary complications even when general anesthesia is avoided.…”

Section: Discussionmentioning

confidence: 64%

Perioperative impact of sleep apnea in a high-volume specialty practice with a strong focus on regional anesthesia: a database analysis

Pichler

Weinstein

Cozowicz

et al. 2019

Regional Anesthesia &Amp; Pain Medicine

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Background and objectivesObstructive sleep apnea (OSA) is a risk factor for adverse postoperative outcome and perioperative professional societies recommend the use of regional anesthesia to minimize perioperative detriment. We studied the impact of OSA on postoperative complications in a high-volume orthopedic surgery practice, with a strong focus on regional anesthesia.MethodsAfter Institutional Review Board approval, 41 766 cases of primary total hip and knee arthroplasties (THAs/TKAs) from 2005 to 2014 were extracted from institutional data of the Hospital for Special Surgery (approximately 5000 THAs and 5000 TKAs annually, of which around 90% under neuraxial anesthesia).The main effect was OSA (identified by the International Classification of Diseases, ninth revision codes); outcomes of interest were cardiac, pulmonary, gastrointestinal, renal/genitourinary, thromboembolic complications, delirium, and prolonged length of stay (LOS). Multivariable logistic regression models provided ORs, corresponding 95% CIs, and p values.ResultsOverall, OSA was seen in 6.3% (n=1332) of patients with THA and 9.1% (n=1896) of patients with TKA. After adjustment for relevant covariates, OSA was significantly associated with 87% (OR 1.87, 95% CI 1.51 to 2.30), 52% (OR 1.52, 95% CI 1.13 to 2.04), and 44% (OR 1.44,95% CI 1.31 to 1.57) increased odds for pulmonary gastrointestinal complications, and prolonged LOS, respectively. The odds for other outcomes remained unaltered by OSA diagnosis.ConclusionWe showed that, even in a setting with almost universal regional anesthesia use, OSA was associated with increased odds for prolonged LOS, and pulmonary and gastrointestinal complications. This puts forward the question of how effective regional anesthesia is in mitigating postoperative complications in patients with OSA.

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Perioperative Complications in Patients With Sleep Apnea Undergoing Total Joint Arthroplasty

Cited by 29 publications

References 21 publications

Society of Anesthesia and Sleep Medicine Guideline on Intraoperative Management of Adult Patients With Obstructive Sleep Apnea

Society of Anesthesia and Sleep Medicine Guideline on Intraoperative Management of Adult Patients With Obstructive Sleep Apnea

Risk stratification in primary total joint arthroplasty: the current state of knowledge

Perioperative impact of sleep apnea in a high-volume specialty practice with a strong focus on regional anesthesia: a database analysis

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