Post-operative outcomes and anesthesia type in total hip arthroplasty in patients with obstructive sleep apnea: A retrospective analysis of the State Inpatient Databases

J Clin Anesth. 2021 May:69:110159. doi: 10.1016/j.jclinane.2020.110159. Epub 2020 Dec 18.


Study objectives: To investigate postoperative outcomes following total hip arthroplasty (THA) in patients with obstructive sleep apnea (OSA). To evaluate trends in the use of regional anesthesia (RA) versus general anesthesia (GA) following the publication of practical guidelines. To compare postoperative outcomes according to anesthesia type.

Design: Retrospective analysis.

Setting: Operating room.

Patients: 349,008 patients who underwent elective THA in Florida, New York, Maryland, and Kentucky between 2007 and 2014 were extracted from the State Inpatient Databases (SID), Healthcare Cost and Utilization Project, including 18,063 patients with OSA (5.2%).

Interventions: No intervention.

Measurements: The effect of OSA on postoperative outcomes was investigated using bivariate analysis and multivariable logistic regression models. Outcomes studied included in-hospital mortality, postoperative complications, length of stay (LOS), and post-discharge readmissions. In a population from New York only, (n = 105,838 with 5306 patients with OSA [5.0%]), we investigated the outcomes in the OSA population according to the anesthesia type. Analysis was performed overall and for each individual year.

Main results: The OSA prevalence increased from 1.7% in 2007 to 7.1% in 2014. In multivariable analysis, there was no effect of OSA on in-hospital mortality (aOR:0.57; 0.31-1.04). Postoperative complications, LOS, and readmission rates were all higher in patients with OSA. In patients with OSA receiving GA than those receiving RA, we found a higher rate of complications overall and pulmonary complications specifically in men and higher rate of 90-day readmission in women. Over the study period, the rate of GA use in patients with OSA increased.

Conclusions: The OSA prevalence in patients undergoing THA increased fourfold over the study period. OSA was associated with increased overall postoperative complications, LOS, and readmission, but not with in-hospital mortality. Despite the publication of guidelines favoring RA over GA, the use of GA increased over the study period.

Keywords: Anesthesia type; Obstructive sleep apnea; Orthopedic surgery; Outcomes.

MeSH terms

  • Aftercare
  • Anesthesia, General / adverse effects
  • Arthroplasty, Replacement, Hip* / adverse effects
  • Female
  • Florida
  • Humans
  • Inpatients
  • Length of Stay
  • Male
  • New York / epidemiology
  • Patient Discharge
  • Postoperative Complications / epidemiology
  • Retrospective Studies
  • Risk Factors
  • Sleep Apnea, Obstructive* / epidemiology