Sleep Apnea in Total Joint Arthroplasty Patients and the Role for Cardiac Biomarkers for Risk Stratification: an Exploration of Feasibility

Lyons, M. Melanie; Bhatt, Nitin; Kneeland-Szanto, Elizabeth; Keenan, Brendan T.; Pechar, J; Stearns, Branden; Elkassabany, Nabil; Memtsoudis, Stavros G.; Pack, Allan I.; Gurubhagavatula, Indira

doi:10.2217/bmm.16.1

Cited by 8 publications

(4 citation statements)

References 163 publications

(311 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

Section: Postoperative Managementmentioning

confidence: 99%

“…95 As such, the identification of accurate metrics of risk with stronger predictive value than the AHI (eg, Spo 2 or blood CO 2 levels, high-resolution pulse oximetry, cardiac biomarkers, indicators of arousal thresholds) is long needed to facilitate increased patient safety in OSA. 17,[97][98][99][100] Moreover, new methods and technologies should be investigated because early patterns of clinical instability and evolving death may be too complex for early detection by any unifying numeric threshold. 17 In conclusion, the diversity and vulnerability of OSA demand a systematic clinical approach for the implementation of aligned and effective measures that provide increased perioperative safety for this This manuscript was handled by: Toby N. Weingarten, MD.…”

Section: Challenges and Future Researchmentioning

confidence: 99%

See 1 more Smart Citation

Perioperative Management of the Patient With Obstructive Sleep Apnea: A Narrative Review

Cozowicz

Memtsoudis

2021

Anesthesia &Amp; Analgesia

View full text Add to dashboard Cite

The prevalence of obstructive sleep apnea (OSA) has reached 1 billion people worldwide, implying significant risk for the perioperative setting as patients are vulnerable to cardiopulmonary complications, critical care requirement, and unexpected death. This review summarizes main aspects and considerations for the perioperative management of OSA, a condition of public health concern. Critical determinants of perioperative risk include OSA-related changes in upper airway anatomy with augmented collapsibility, diminished capability of upper airway dilator muscles to respond to airway obstruction, disparities in hypoxemia and hypercarbia arousal thresholds, and instability of ventilatory control. Preoperative OSA screening to identify patients at increased risk has therefore been implemented in many institutions. Experts recommend that in the absence of severe symptoms or additional compounding health risks, patients may nevertheless proceed to surgery, while heightened awareness and the adjustment of postoperative care is required. Perioperative caregivers should anticipate difficult airway management in OSA and be prepared for airway complications. Anesthetic and sedative drug agents worsen upper airway collapsibility and depress central respiratory activity, while the risk for postoperative respiratory compromise is further increased with the utilization of neuromuscular blockade. Consistently, opioid analgesia has proven to be complex in OSA, as patients are particularly prone to opioid-induced respiratory depression. Moreover, basic features of OSA, including intermittent hypoxemia and repetitive sleep fragmentation, gradually precipitate a higher sensitivity to opioid analgesic potency along with an increased perception of pain. Hence, regional anesthesia by blockade of neural pathways directly at the site of surgical trauma as well as multimodal analgesia by facilitating additive and synergistic analgesic effects are both strongly supported in the literature as interventions that may reduce perioperative complication risk. Health care institutions are increasingly allocating resources, including those of postoperative enhanced monitoring, in an effort to increase patient safety. The implementation of evidence-based perioperative management strategies is however burdened by the rising prevalence of OSA, the large heterogeneity in disease severity, and the lack of evidence on the efficacy of costly perioperative measures. Screening and monitoring algorithms, as well as reliable risk predictors, are urgently needed to identify OSA patients that are truly in need of extended postoperative surveillance and care. The perioperative community is therefore challenged to develop feasible pathways and measures that can confer increased patient safety and prevent complications in patients with OSA.

show abstract

Section: Postoperative Managementmentioning

confidence: 99%

Section: Challenges and Future Researchmentioning

confidence: 99%

Perioperative Management of the Patient With Obstructive Sleep Apnea: A Narrative Review

Cozowicz

Memtsoudis

2021

Anesthesia &Amp; Analgesia

View full text Add to dashboard Cite

show abstract

“…82,83 In elderly patients without a history of dementia who elect to undergo elective TJA, there is an association between preexisting OSA and postoperative dementia, which can lead to longer lengths of hospital stay and perioperative complications. 84…”

Section: Review Articlementioning

confidence: 99%

Roth’s Spots, a clinical diagnostic clue for Infective Endocarditis

Arora

Dhibar

Bashyal³

et al. 2020

TPJ

View full text Add to dashboard Cite

An improved understanding of the implications of race on body satisfaction might optimize the weight loss process and quality of life in women with obesity. The findings of this study increased understanding of body satisfaction in women with obesity and have implications for addressing psychosocial factors within weight loss treatments across racial and at-risk groups. 24 Physicians' Views on a Wellbeing Course Gifted to Them: A Qualitative Study. Patricia Lynn Dobkin; Camila Velez Given concerns about staff burnout and distress, the Chief of the Department of Medicine sponsored the Physician Wellbeing program making it cost-free for doctors at a large academic medical setting. Ninety doctors registered within the one-year pilot project time frame. Following a Mind-Body Medicine online and Mindful Medical Practice workshop a qualitative study was conducted to identify physicians' views about the initiative.Physicians who agreed to take part following the workshops were the participants in the study. Physicians supported the integration of wellness programs into medical settings where stress is an inherent aspect of the work environment. They were grateful for the "gift" of being valued and supported by the administration.

show abstract

“…In fact, the American Society of Anesthesiologists recommends early identification and preparation for SA due to increased risks of respiratory depression from anesthetics/analgesia, increased postoperative reintubations, cardiac dysrhythmias, and longer hospital stays [8]. Hence, there are an innumerable amount of SA patients at risk for arrhythmias, respiratory complications, hypercoagulable disorders, neurologic deviations, wound breakdown/infection, and even death [12].…”

Section: Introductionmentioning

confidence: 99%

How does sleep apnea impact outcomes following primary total hip arthroplasty for femoral neck fractures: a matched-control analysis

Golub

Conway

et al. 2021

Arch Orthop Trauma Surg

View full text Add to dashboard Cite

Background Cross-sectional studies have demonstrated that the prevalence of sleep apnea (SA) to be increasing within the United States. While studies have shown the association of SA and its association on complications following elective orthopedic procedures, well-powered studies investigating its impact in a traumatic setting are limited. The purpose of this study was to determine whether SA patients undergoing primary total hip arthroplasty (THA) for femoral neck fractures have higher rates of: (1) hospital lengths of stay (LOS); (2) readmissions; (3) complications; and (4) healthcare expenditures. Methods The 100% Medicare Standard Analytical Files was queried from 2005 to 2014 for patients who sustained femoral neck fractures and were treated with primary THA. The study group consisted of patients with concomitant diagnoses of SA, whereas patients without SA served as controls. Study group patients were matched to controls in a 1:5 ratio by age, sex, and various comorbid conditions. Demographics of the cohorts were compared using Pearson's chi-squared analyses, and multivariate logistic regression analyses were used to calculate the odds (OR) of the effects of SA on postoperative outcomes. A p value less than 0.006 was considered to be statistically significant. ResultsThe final query yielded 24,936 patients within the study (n = 4166) and control (n = 20,770) cohorts. SA patients had significantly longer in-hospital LOS (6 vs. 5 days, p < 0.0001) but similar readmission rates (24.12 vs. 20.50%; OR: 1.03, p = 0.476). SA patients had significantly higher frequency and odds of developing medical complications (72.66 vs. 43.85%; OR: 1.57, p < 0.0001), and higher healthcare costs ($22,743.79 vs. $21,572.89, p < 0.0001). Conclusion SA is associated with longer in-hospital LOS, higher rates of complications and healthcare expenditures. This study is vital as it can allow orthopaedists to educate patients with SA on the potential complications which may occur following their procedure. Level of evidence III.

show abstract

Sleep Apnea in Total Joint Arthroplasty Patients and the Role for Cardiac Biomarkers for Risk Stratification: an Exploration of Feasibility

Cited by 8 publications

References 163 publications

Perioperative Management of the Patient With Obstructive Sleep Apnea: A Narrative Review

Perioperative Management of the Patient With Obstructive Sleep Apnea: A Narrative Review

Roth’s Spots, a clinical diagnostic clue for Infective Endocarditis

How does sleep apnea impact outcomes following primary total hip arthroplasty for femoral neck fractures: a matched-control analysis

Contact Info

Product

Resources

About