Sleep Apnea Increases Ninety-Day Complications and Cost Following Primary Total Joint Arthroplasty

Vakharia, Rushabh M.; Cohen-Levy, Wayne B.; Vakharia, Ajit M.; Donnally, Chester J.; Law, Tsun Yee; Roche, Martin W.

doi:10.1016/j.arth.2018.12.018

Cited by 35 publications

(38 citation statements)

References 47 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our findings in patients undergoing operation for PLLI are consistent with previous literature that shows an increase in respiratory complications in patients undergoing elective lower extremity orthopedic procedures. 6 10 11 The literature has also previously shown higher non-pulmonary complications in patients with sleep apnea undergoing lower extremity orthopedic procedures, 12 yet in this study we chose to focus just on pulmonary complications. OSA is a disease that is highly underdiagnosed and underreported in the general population.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary complications in trauma patients with obstructive sleep apnea undergoing pelvic or lower limb operation

Fiorentino

Hwang

Pentakota

et al. 2020

Trauma Surg Acute Care Open

View full text Add to dashboard Cite

BackgroundObstructive sleep apnea (OSA) is increasingly prevalent in the range of 2% to 24% in the US population. OSA is a well-described predictor of pulmonary complications after elective operation. Yet, data are lacking on its effect after operations for trauma. We hypothesized that OSA is an independent predictor of pulmonary complications in patients undergoing operations for traumatic pelvic/lower limb injuries (PLLI).MethodsNationwide Inpatient Sample (2009–2013) was queried for International Classification of Diseases, Ninth Revision, Clinical Modification codes for PLLI requiring operation. Elective admissions and those with concurrent traumatic brain injury with moderate to prolonged loss of consciousness were excluded. Outcome measures were pulmonary complications including ventilatory support, ventilator-associated pneumonia, pulmonary embolism (PE), acute respiratory distress syndrome (ARDS), and respiratory failure. Multivariable logistic regression analysis was used, adjusting for OSA, age, sex, race/ethnicity, and specific comorbidities (obesity, chronic lung disease, and pulmonary circulatory disease). P<0.01 was considered statistically significant.ResultsAmong the 337 333 patients undergoing PLLI operation 3.0% had diagnosed OSA. Patients with OSA had more comorbidities and were more frequently discharged to facilities. Median length of stay was longer in the OSA group (5 vs 4 days, p<0.001). Pulmonary complications were more frequent in those with OSA. Multivariable logistic regression showed that OSA was an independent predictor of ventilatory support (adjusted odds ratio (aOR), 1.37; 95% CI,1.24 to 1.51), PE (aOR 1.40; 95% CI, 1.15 to 1.70), ARDS (aOR 1.36; 95% CI,1.23 to 1.52), and respiratory failure (aOR 1.90; 95% CI, 1.74 to 2.06).ConclusionOSA is an independent and underappreciated predictor of pulmonary complications in those undergoing emergency surgery for PLLI. More aggressive screening and identification of OSA in trauma patients undergoing operation are necessary to provide closer perioperative monitoring and interventions to reduce pulmonary complications and improve outcomes.Level of evidencePrognostic Level IV.

show abstract

Section: Discussionmentioning

confidence: 99%

Pulmonary complications in trauma patients with obstructive sleep apnea undergoing pelvic or lower limb operation

Fiorentino

Hwang

Pentakota

et al. 2020

Trauma Surg Acute Care Open

View full text Add to dashboard Cite

show abstract

“…The supercomputer houses over 100 million patients from the Medicare and Humana claims and has been used extensively for orthopaedic-related research. [11][12][13][14] The database relies on International Classification of Disease, Ninth Revision (ICD-9) and Current Procedural Terminology (CPT) coding to provide information such as diagnoses, complications, and discharge dispositions, in addition to other metrics. The deidentified information is provided as a comma separated value output file.…”

Section: Methodsmentioning

confidence: 99%

The Effects of Rheumatoid Arthritis on In-Hospital Lengths of Stay, Complications, and Costs following Primary Total Hip Arthroplasty: A Matched-Control Study

Vakharia

Gwam

Luo

et al. 2020

The Journal of Hip Surgery

Self Cite

View full text Add to dashboard Cite

Studies investigating the relationship of rheumatoid arthritis (RA) in patients undergoing primary total hip arthroplasty (THA) are limited. Therefore, the purpose of this study was to analyze whether RA patients undergoing primary THA have higher rates of: (1) in-hospital lengths of stay (LOS), (2) medical complications, (3) implant-related complications, and (4) costs of care. A query using an administrative claims database was performed identifying patients who underwent primary THA with RA, whereas patients without RA served as controls. Study group patients were matched to controls in a 1:5 ratio by age, sex, and medical comorbidities. The query yielded 518,927 patients with (n = 86,507) and without (n = 432,420) RA undergoing primary THA. A p-value of less than 0.002 was considered statistically significant. Patients with RA were found to have significantly longer in-hospital LOS (4 vs. 3 days, p < 0.0001). Additionally, RA patients had significantly higher incidence and odds (odds ratio [OR]) of medical (6.39 vs. 1.18%; OR: 5.71, p < 0.0001) and implant-related complications (7.45 vs. 3.35%; OR: 2.32, p < 0.0001) compared with patients without RA. Furthermore, RA patients were found to have significantly higher day of surgery ($12,422.19 vs. $12,103.08, p < 0.0001) and total global 90-day episode of care costs ($16,560.40 vs. $15,167.67, p < 0.0001). This study of 518,927 patients demonstrates patients with RA undergoing primary THA have significantly longer in-hospital LOS, in addition to higher rates of complications and costs. The study is informative as orthopaedists can adequately counsel and educate RA patients of the potential complications which may occur following their procedure.

show abstract

“…When we have two populations, the database moves all patients from the smaller cohort into a new population, and randomly selects the same number of patients from the larger group per the predefined matching parameters, as demonstrated in previous studies. [20][21][22] The query yielded 72,326 patients who had (n ¼ 18,082) or did not have (n ¼ 54,244) PD. Matching was successful as there were no statistical differences between the cohorts for the matching parameters (►Table 1).…”

Section: Study Populationsmentioning

confidence: 99%

Impact of Parkinson's Disease on Complications, Readmission Rates, and Costs of Care following Primary Total Knee Arthroplasty

et al. 2020

View full text Add to dashboard Cite

Large-scale studies evaluating the effects of Parkinson's disease (PD) on primary total knee arthroplasty (TKA) are limited. The purpose of this study was to determine if PD patients undergoing primary TKA have increased: (1) medical complications; (2) implant-related complications; (3) readmission rates; and (4) costs. A query was performed using an administrative claims database. The study group consisted of all patients undergoing primary TKA who had a history of PD. Matched non-PD patients undergoing primary TKA served as a control group. The query yielded 72,326 patients (PD = 18,082; matching cohort = 54,244). Pearson's chi-square tests, logistic regression analyses, and Welch's t-tests were used to test for significance between the cohorts. Primary TKA patients who had PD were found to have greater incidences and odds of medical complications (4.21 vs. 1.24%; odds ratio [OR]: 3.50, 95% confidence interval [CI]: 3.15–3.89, p < 0.0001) and implant-related complications (5.09 vs. 3.15%; OR: 1.64, 95% CI: 1.51–1.79, p < 0.0001) compared with the matching cohort. Additionally, the rates and odds of 90-day readmission were higher (16.29 vs. 12.66%; OR:1.34, p < 0.0001) and episodes of care costs were significantly greater ($17,105.43 vs. $15,252.34, p < 0.0001) in patients who had PD. Results demonstrate that PD patients undergoing primary TKA had higher incidences of medical and implant-related complications. They also had increased 90-day readmission rates and costs compared with controls. The findings of this study should be used in risk stratification and should inform physician–patient discussion but should not be arbitrarily used to deny access to care.

show abstract

Sleep Apnea Increases Ninety-Day Complications and Cost Following Primary Total Joint Arthroplasty

Cited by 35 publications

References 47 publications

Pulmonary complications in trauma patients with obstructive sleep apnea undergoing pelvic or lower limb operation

Pulmonary complications in trauma patients with obstructive sleep apnea undergoing pelvic or lower limb operation

The Effects of Rheumatoid Arthritis on In-Hospital Lengths of Stay, Complications, and Costs following Primary Total Hip Arthroplasty: A Matched-Control Study

Impact of Parkinson's Disease on Complications, Readmission Rates, and Costs of Care following Primary Total Knee Arthroplasty

Contact Info

Product

Resources

About