Lu Jiao, Xie Haiyang, Chen Jianwen, Ma Bingjiang, He Jiangtao, Chen Qian, Li Shuliang
Department of Urological Surgery, People's Hospital of Yuechi County, Guang'an, 638300, Sichuan, People's Republic of China.
Department of Orthopaedics, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, Sichuan, People's Republic of China.
J Orthop Surg Res. 2025 Apr 9;20(1):351. doi: 10.1186/s13018-025-05777-1.
Obstructive sleep apnea (OSA) is a prevalent sleep disorder associated with intermittent hypoxia, oxidative stress, and systemic inflammation, posing risks for adverse postoperative outcomes, including surgical site infections (SSIs). Elderly patients undergoing posterior lumbar interbody fusion (PLIF) are particularly susceptible to SSIs due to advanced age, comorbidities, and prolonged surgical times. However, the role of OSA in increasing SSI risk among this population remains unclear.
This retrospective cohort study analyzed 478 elderly PLIF patients from a single institution between May 2016 and June 2024. Of these, 113 were diagnosed with OSA. Propensity score matching (PSM) was performed to balance baseline characteristics, resulting in 83 matched pairs. SSI rates, hospital stays, and readmission rates were compared between the OSA and non-OSA groups. Subgroup analysis was conducted to evaluate the effects of continuous positive airway pressure (CPAP) or automatic positive airway pressure (APAP) therapy on postoperative outcomes.
After PSM, OSA patients demonstrated a significantly higher SSI incidence (13.3% vs. 3.6%, p = 0.04) compared to non-OSA patients. On multivariate analysis, OSA was the only factor that remained significantly associated with an increased risk of SSIs (Odds Ratio = 4.509, 95% CI: 1.283-21.504, p = 0.03). OSA patients also experienced longer hospital stays (10.1 ± 2.9 vs. 9.1 ± 2.0 days, p = 0.01) and elevated 30-day readmission rates (9.6% vs. 1.2%, p = 0.02). Subgroup analysis revealed that CPAP/APAP therapy reduced SSI incidence (3.9% vs. 17.5%, p = 0.08) and shortened hospital stays (9.1 ± 1.5 vs. 10.5 ± 3.2 days, p = 0.03) among OSA patients.
OSA significantly increases the risk of early SSIs and prolongs hospital stays in elderly PLIF patients. Subgroup analysis suggests that CPAP/APAP therapy may have benefits to OSA patients, though this association requires validation through prospective studies. These findings emphasize the importance of preoperative OSA screening and management to improve surgical outcomes in this high-risk population.
阻塞性睡眠呼吸暂停（OSA）是一种常见的睡眠障碍，与间歇性缺氧、氧化应激和全身炎症相关，会增加术后不良结局的风险，包括手术部位感染（SSI）。接受后路腰椎椎间融合术（PLIF）的老年患者由于年龄较大、合并多种疾病以及手术时间延长，特别容易发生SSI。然而，OSA在增加该人群SSI风险中的作用仍不明确。
这项回顾性队列研究分析了2016年5月至2024年6月期间来自单一机构的478例老年PLIF患者。其中，113例被诊断为OSA。进行倾向评分匹配（PSM）以平衡基线特征，最终得到83对匹配病例。比较了OSA组和非OSA组的SSI发生率、住院时间和再入院率。进行亚组分析以评估持续气道正压通气（CPAP）或自动气道正压通气（APAP）治疗对术后结局的影响。
PSM后，与非OSA患者相比，OSA患者的SSI发生率显著更高（13.3%对3.6%，p = 0.04）。多因素分析显示，OSA是唯一与SSI风险增加仍显著相关的因素（比值比 = 4.509，95%可信区间：1.283 - 21.504，p = 0.03）。OSA患者的住院时间也更长（10.1 ± 2.9天对9.1 ± 2.0天，p = 0.01），30天再入院率更高（9.6%对1.2%，p = 0.02）。亚组分析显示，CPAP/APAP治疗降低了OSA患者的SSI发生率（3.9%对17.5%，p = 0.08），并缩短了住院时间（9.1 ± 1.5天对10.5 ± 3.2天，p = 0.03）。
OSA显著增加老年PLIF患者早期SSI的风险并延长住院时间。亚组分析表明，CPAP/APAP治疗可能对OSA患者有益，尽管这种关联需要通过前瞻性研究来验证。这些发现强调了术前OSA筛查和管理对于改善这一高危人群手术结局的重要性。
