Luna I E, Kehlet H, Olsen R M, Wede H R, Hoevsgaard S J, Aasvang E K
The Lundbeck Centre for fast-track Hip and Knee Arthroplasty, Copenhagen, Denmark.
Section of Surgical Pathophysiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
Acta Anaesthesiol Scand. 2020 Nov;64(10):1405-1413. doi: 10.1111/aas.13671. Epub 2020 Aug 17.
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.
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.
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.
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.
术后低氧血症在住院患者中很常见，可能对恢复产生不利影响。然而，关于出院后阶段的数据以及持续时间、严重程度和潜在风险因素的详细信息却很少。因此，我们通过持续夜间血氧饱和度监测，调查了全髋关节置换术（THA）/全膝关节置换术（TKA）后第一周内严重血氧饱和度降低的发生率和风险因素。
本研究是对112例接受快速通道THA/TKA的患者进行的前瞻性队列研究的二次分析。排除已知睡眠呼吸暂停的患者。在手术前2晚和术后7晚，通过无线腕戴式脉搏血氧仪记录血氧饱和度和心率。分别从病历、患者日记和临床测试中收集人口统计学、阿片类药物使用情况和认知功能的数据。主要结局是发生严重血氧饱和度降低，定义为饱和度<85%持续≥10分钟的时间段。次要结局包括各种饱和度水平的描述和相关风险因素。
35%的患者在术后第一周出现严重氧饱和度降低。术后第一天后，低氧血症发作的持续时间和严重程度增加。术前低氧血症发作显著增加了术后低氧血症事件的风险（比值比2.4 - 4.4，可信区间0.4 - 46），而术前和术后阿片类药物的使用、年龄、性别、美国麻醉医师协会（ASA）分级、手术类型或麻醉与术后低氧血症的发生显著相关。
三分之一的患者在THA/TKA出院后的第一周内出现严重夜间低氧血症发作增加且持续时间延长的情况。严重低氧血症发作风险增加与术前低氧血症有关。
