Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania.
Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts.
J Arthroplasty. 2024 Dec;39(12):3119-3127.e1. doi: 10.1016/j.arth.2024.06.015. Epub 2024 Jun 14.
Obstructive sleep apnea (OSA) has been linked to multiple adverse health outcomes and postoperative complications. Despite the high prevalence of OSA in patients undergoing total joint arthroplasty (TJA), few studies have evaluated the postoperative course of OSA patients after joint arthroplasty surgery.
PubMed (MEDLINE) and Scopus (EMBASE, MEDLINE, and COMPENDEX) were used to conduct a systematic review of articles from inception to July 2023. Primary studies comparing postoperative outcomes following TJA between patients who had and did not have OSA were included. Postoperative medical complications, utilization of critical care, hospital stay, and mortality data were extracted. Descriptive statistics and random-effects meta-analysis models were used to analyze the available data. Included studies were evaluated for methodological risks of bias using the risk of bias in non-randomized studies of interventions. This review was registered on the International Prospective Register of Systematic Reviews (ID: CRD42023447610).
There were 7 studies with a total of 20,977 patients (9,425 hip; 11,137 knee; 415 hip or knee) that were included. Pulmonary complications were most frequently studied, followed by thromboembolic events. Cardiac, gastrointestinal, hematologic, genitourinary, and delirium events were also reported across studies. Meta-analysis revealed that OSA patients had 4-fold increased odds of overall medical complications (OR [odds ratio], 4.23; 95% confidence interval (CI), 2.97 to 6.04; P < .001; I = 0%), 4-fold increased odds of pulmonary complications (OR, 4.31; 95% CI, 2.82 to 6.60; P < .001; I = 0%), 2-fold increased odds of thromboembolic complications (OR, 1.92; 95% CI, 1.22 to 3.03; P = .005; I = 9%), and 4-fold increased odds of delirium (OR, 3.94; 95% CI, 1.72 to 9.04; P = .001; I = 0%).
A significant association was found between OSA and overall medical, pulmonary, and thromboembolic complications. These patients also had a higher incidence of postoperative delirium. The present findings underscore the need for comprehensive perioperative strategies to mitigate these risks in OSA patients who elect to undergo TJA.
阻塞性睡眠呼吸暂停（OSA）与多种不良健康后果和术后并发症有关。尽管在接受全关节置换术（TJA）的患者中 OSA 患病率很高，但很少有研究评估关节置换术后 OSA 患者的术后病程。
使用 PubMed（MEDLINE）和 Scopus（EMBASE、MEDLINE 和 COMPENDEX）对从开始到 2023 年 7 月的文章进行系统综述。纳入比较 TJA 后 OSA 患者与无 OSA 患者术后结局的原发性研究。提取术后医疗并发症、重症监护使用、住院时间和死亡率数据。使用描述性统计和随机效应荟萃分析模型分析可用数据。使用干预措施的非随机研究的偏倚风险评估工具评估纳入研究的方法学风险偏倚。本综述在国际前瞻性系统评价注册库（ID：CRD42023447610）进行了注册。
共纳入 7 项研究，总计 20977 例患者（9425 例髋关节；11137 例膝关节；415 例髋关节或膝关节）。最常研究的是肺部并发症，其次是血栓栓塞事件。研究中还报告了心脏、胃肠道、血液、泌尿生殖和谵妄事件。荟萃分析显示，OSA 患者总体医疗并发症的发生几率增加了 4 倍（OR [比值比]，4.23；95%置信区间[CI]，2.97 至 6.04；P<0.001；I²=0%），肺部并发症的发生几率增加了 4 倍（OR，4.31；95% CI，2.82 至 6.60；P<0.001；I²=0%），血栓栓塞并发症的发生几率增加了 2 倍（OR，1.92；95% CI，1.22 至 3.03；P=0.005；I²=9%），谵妄的发生几率增加了 4 倍（OR，3.94；95% CI，1.72 至 9.04；P=0.001；I²=0%）。
OSA 与总体医疗、肺部和血栓栓塞并发症之间存在显著关联。这些患者术后谵妄的发生率也较高。这些发现强调了在选择接受 TJA 的 OSA 患者中，需要综合围手术期策略来降低这些风险。
