The impact of obstructive sleep apnea on early surgical site infections in elderly PLIF patients: a retrospective propensity score-matched analysis.

BACKGROUND

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.

METHODS

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.

RESULTS

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.

CONCLUSION

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.