Golub Ivan J, Ng Mitchell K, Conway Charles A, Vakharia Rushabh M, Cannada Lisa K, Kang Kevin K
Department of Orthopaedic Surgery, Maimonides Medical Center, 4802 10th Avenue, Brooklyn, NY, 11219, USA.
Novart Health, Charlotte, NC, USA.
Arch Orthop Trauma Surg. 2023 Jan;143(1):295-300. doi: 10.1007/s00402-021-04070-0. Epub 2021 Jul 21.
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.
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.
The 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).
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.
III.
横断面研究表明，美国睡眠呼吸暂停（SA）的患病率正在上升。虽然研究已经表明SA与择期骨科手术后并发症之间的关联，但关于其在创伤环境中影响的有力研究有限。本研究的目的是确定因股骨颈骨折接受初次全髋关节置换术（THA）的SA患者是否在以下方面有更高的发生率：（1）住院时间（LOS）；（2）再入院率；（3）并发症；（4）医疗保健支出。
查询2005年至2014年100%的医疗保险标准分析文件，以获取股骨颈骨折并接受初次THA治疗的患者。研究组由伴有SA诊断的患者组成，而无SA的患者作为对照。研究组患者按年龄、性别和各种合并症以1:5的比例与对照组匹配。使用Pearson卡方分析比较队列的人口统计学特征，并使用多因素逻辑回归分析计算SA对术后结果影响的比值比（OR）。p值小于0.006被认为具有统计学意义。
最终查询得到研究队列（n = 4166）和对照队列（n = 20770）中的24936名患者。SA患者的住院LOS明显更长（6天对5天，p < 0.0001），但再入院率相似（24.12%对20.50%；OR：1.03，p = 0.476）。SA患者发生医疗并发症的频率和几率明显更高（72.66%对43.85%；OR：1.57，p < 0.0001），医疗保健成本更高（22743.79美元对21572.89美元，p < 0.0001）。
SA与更长的住院LOS、更高的并发症发生率和医疗保健支出相关。这项研究至关重要，因为它可以让骨科医生告知SA患者其手术后可能发生的潜在并发症。
III级。
