Department of Orthopaedic Surgery, CHU de Québec-Université Laval, Quebec City, QC, Canada.
Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
J Arthroplasty. 2024 Aug;39(8):1982-1987.e1. doi: 10.1016/j.arth.2024.02.020. Epub 2024 Feb 12.
Up to 25% of patients requiring hip or knee arthroplasty have sleep apnea (SA), and these patients have historically been excluded from outpatient programs. The objectives of this study were to evaluate same-day discharge failure as well as 30-day complications, readmissions, and unexpected visits.
A retrospective case-control study comparing patients who have and do not have SA matched for age, sex and arthroplasty type (total hip arthroplasty, total knee arthroplasty, unicompartimental knee arthroplasty) who underwent primary outpatient surgery between February 2019 and December 2022 in 2 academic hospitals was conducted. Cases with mild SA, moderate SA with a body mass index (BMI) <35, and SA of all severity treated by continuous positive airway pressure machines were eligible. There were 156 patients included (78 cases). Complications were assessed according to the Clavien-Dindo Classification and the Comprehensive Complication Index. Continuous variables were evaluated by Student's T or Mann-Whitney tests, while categorical data were analyzed by Chi-square or Fisher tests. Univariate analyses were performed to determine discharge failure risk factors.
There were 6 cases (7.7%) and 5 controls (6.4%) who failed to be discharged on surgery day (P = .754), with postoperative hypoxemia (6, [3.8%]) and apnea periods (3, [1.9%]) being the most common causes. Higher BMI (odds ratio = 1.19, P = .013) and general anesthesia (odds ratio = 11.97, P = .004) were found to be risk factors for discharge failure. No difference was observed on 30-day readmissions (P = .497), unexpected visits (P = 1.000), and complications on the Clavien-Dindo Classification (P > .269) and Comprehensive Complication Index (P > .334) scales.
Selected patients who have SA can safely undergo outpatient hip or knee arthroplasty. Higher BMI and general anesthesia increased the odds of same-day discharge failure.
Level III, Case-control Study.
多达 25%需要髋关节或膝关节置换术的患者患有睡眠呼吸暂停（SA），这些患者在历史上被排除在门诊计划之外。本研究的目的是评估当日出院失败以及 30 天的并发症、再入院和意外就诊。
这是一项回顾性病例对照研究，比较了在 2019 年 2 月至 2022 年 12 月期间在 2 所学术医院接受原发性门诊手术的、患有和不患有 SA 的患者，这些患者按年龄、性别和关节置换类型（全髋关节置换术、全膝关节置换术、单髁膝关节置换术）进行匹配。患有轻度 SA、BMI<35 的中度 SA 且所有严重程度的 SA 均使用持续气道正压通气机治疗的患者符合条件。共纳入 156 例患者（78 例）。并发症根据 Clavien-Dindo 分类和综合并发症指数进行评估。连续变量通过学生 t 检验或曼-惠特尼检验进行评估，而分类数据通过卡方或 Fisher 检验进行分析。进行单变量分析以确定出院失败的危险因素。
有 6 例（7.7%）和 5 例（6.4%）患者在手术当天未能出院（P=.754），最常见的原因是术后低氧血症（6 例，[3.8%]）和呼吸暂停期（3 例，[1.9%]）。较高的 BMI（优势比=1.19，P=.013）和全身麻醉（优势比=11.97，P=.004）被发现是出院失败的危险因素。30 天再入院（P=.497）、意外就诊（P=1.000）、Clavien-Dindo 分类（P>.269）和综合并发症指数（P>.334）上的并发症无差异。
选择患有 SA 的患者可以安全地进行门诊髋关节或膝关节置换术。较高的 BMI 和全身麻醉增加了当日出院失败的几率。
III 级，病例对照研究。
