Sterneder Christian Manuel, Streck Laura Elisa, Haralambiev Lyubomir, Hanreich Carola, Boettner Friedrich
Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, USA.
Department of Orthopedic Surgery, University Hospital Ulm, Ulm, Germany.
Arch Orthop Trauma Surg. 2025 Jun 9;145(1):340. doi: 10.1007/s00402-025-05954-1.
In patients undergoing total knee arthroplasty (TKA) obstructive sleep apnea (OSA) is common. Our retrospective study aimed to investigate whether perioperative outcome differ between patients with low-moderate OSA risk and patients with high OSA risk and whether the perioperative outcomes of patients with and without CPAP (continuous positive airway pressure) device differ.
After excluding patients (missing STOP-Bang-Score, concomitant lung disease) 1444 TKA operated between 2016 and 2020 were included. The STOP-Bang Score was used to determine the risk for OSA (low-moderate risk: Score 0-4, high risk: Score 5-8). SpO2 drops < 90% and readmission rates were compared for low-moderate risk patients and high risk patients as well as for patients with and without CPAP.
There was no difference in SpO2-drops < 90% (1% vs. 1% P = 0.612) and readmission rate (4% vs. 3%, P = 0.537) between low-moderate risk (409 TKA) and high risk patients (1035 TKA). A significant reduction in O2 Flow-Rate (P < 0.001) and no difference in SpO2 (P > 0.999) was observed from post anesthesia care unit to the morning of postoperative day one for both groups. 47% (677/1444) utilized a CPAP machine. There was no difference in the incidence of SpO2 drops < 90% (1% vs. 1%, P = 0.605) and readmission rate (3% vs. 5%, P = 0.055) between both groups.
In the absence of underlying pulmonary disease perioperative outcomes did not differ between TKA patients with a low- moderate OSA risk and patients with a high OSA risk according to the STOP Bang Score regardless of the use of a CPAP machine. Outpatient TKA might be an option for optimized OSA patients (without underlying pulmonary disease) regardless of STOP Bang Score and use of a CPAP machine.
在接受全膝关节置换术（TKA）的患者中，阻塞性睡眠呼吸暂停（OSA）很常见。我们的回顾性研究旨在调查中低OSA风险患者和高OSA风险患者的围手术期结果是否存在差异，以及使用和未使用持续气道正压通气（CPAP）设备的患者围手术期结果是否存在差异。
在排除患者（缺失STOP-Bang评分、合并肺部疾病）后，纳入了2016年至2020年间进行的1444例TKA手术。使用STOP-Bang评分来确定OSA风险（中低风险：评分0-4，高风险：评分5-8）。比较了中低风险患者和高风险患者以及使用和未使用CPAP的患者的SpO2下降<90%的情况和再入院率。
中低风险（409例TKA）和高风险患者（1035例TKA）之间的SpO2下降<90%（1%对1%，P=0.612）和再入院率（4%对3%，P=0.537）没有差异。两组从麻醉后护理单元到术后第1天早晨，氧流量率均显著降低（P<0.001），而SpO2无差异（P>0.999）。47%（677/1444）的患者使用了CPAP机器。两组之间SpO2下降<90%的发生率（1%对1%，P=0.605）和再入院率（3%对5%，P=0.055）没有差异。
在没有潜在肺部疾病的情况下，根据STOP Bang评分，中低OSA风险的TKA患者和高OSA风险的患者围手术期结果没有差异，无论是否使用CPAP机器。对于优化的OSA患者（无潜在肺部疾病），无论STOP Bang评分和是否使用CPAP机器，门诊TKA可能是一种选择。
