Obstructive Sleep Apnea as a Risk Factor After Shoulder Arthroplasty

Transcription

1 Obstructive Sleep Apnea as a Risk Factor After Shoulder Arthroplasty Justin W. Griffin, MD, Wendy M. Novicoff, PhD James A. Browne, MD Stephen F. Brockmeier, MD Department of Orthopaedic Surgery Division of Sports Medicine University of Virginia Medical Center (Correspondence: sfb2e@virginia.edu)

2 Disclosures No payment or service was received from any part for any aspect of the presented work

3 Background Obstructive sleep apnea (OSA) has been identified as an important risk factor in perioperative orthopaedic surgery outcomes Preoperative screening of patients for OSA has become routine in many centers OSA is present in 2-10% of the population The current literature lacks data concerning the risks of OSA specifically in patients undergoing shoulder arthroplasty

4 Goals of our Study To determine the risk of in-hospital postoperative mortality, length-of stay, complications and postoperative charges in patients undergoing shoulder arthroplasty on a national level Relevance Shoulder arthroplasty is on the rise with over 27,000 total shoulder arthroplasties and 20,000 hemiarthroplasties in North America per year OSA has been identified in other populations as a risk factor following prosthetic joint replacement

5 Patients and Methods National Inpatient Sample (NIS) In hospital data only 22,988 patients undergoing TSA or Hemiarthroplasty between 2005 and 2008 Percent OSA: 5.9% Mean Age: 68.8 years Percent TSA: 48.5% Percent Male: 40% Data analyzed using Logarithmic transformation within multivariate analysis with SPSS modeling.

6 Results Variable Total Sample No OSA OSA P Age (years) (SD = 11.59) (SD = 11.7) (SD = 9.48) Female gender Payer 19,984 (60.3% of population) 66.1% Medicare 2.6% Medicaid 26.6% Private 0.7% Self-pay 0.1% No charge 3.9% Other 95.6% of females did NOT have OSA; 91.3% of males did NOT have OSA 94.4% Medicare 94.1% Medicaid 92.7% Private 96.3% Self-pay 96.2% No charge 93.5% Other 4.4% of females had OSA; 8.7% of males had OSA 5.6% Medicare 5.9% Medicaid 7.3% Private 3.7% Self-pay 3.8% No charge 6.5% Other LOS (days) 2.88 (SD = 3.02) 2.89 (SD = 3.07) 2.60 (SD = 3.03) 0.000*** Total Charges ($) $39,904 (SD = $28,650) $39,933 (SD = $28,964) Mortality 54 (0.2%) 52 (0.2% of all patients WITHOUT OSA died) Calendar Year 2005 = 21.3% 2005 = 96.0% 2006 = 23.7% 2006 = 94.1% 2007 = 26.2% 2007 = 93.4% 2008 = 34.4% 2008 = 92.8% Deyo Score 0.35 (SD = 0.84) 0 = 76.2% 1 = 17.0% 2 = 4.7% 3 or more = 1.0% $39,468 (SD = $23,238) 2 (0.1% of patients WITH OSA died) 2005 = 4.0% 2006 = 5.9% 2007 = 6.6% 2008 = 7.2% (SD = 0.04) 0.44 (SD = 0.03) 0.000

7 Results: Mortality Patients with OSA had similar mortality to those without OSA (odds ratio 1.083). 54 patients overall and 2 with OSA

8 Results: Cost No meaningful increase in cost in patients with OSA $39,741 in patients with OSA vs $39,334 in those without OSA

9 Results: Length of Stay Shorter length of stay in patients with OSA Mean, 2.61 vs 2.91 days; P<0.0001

10 Results: Complications Variable Total No OSA OSA P Odds Ratio Sample Hematoma/ 179 (0.5%) 0.5% 0.3% (NS) Seroma Implant 67 (0.2%) 0.2% 0.1% (NS) Infection 25 (0.1%) 0.1% 0.0% (NS) PE 88 (0.3%) 0.3% 0.2% (NS) Cardiac 187 (0.6%) 0.6% 0.2% (NS) Peripheral 17 (0.1%) 0.1% 0.0% (NS) Vascular Disease Respiratory 216 (0.6%) 0.6% 0.8% (NS) Gastrointes tinal Genital- Urinary Central Nervous System 88 (0.3%) 0.3% 0.3% (NS) 174 (0.5%) 0.5% 0.5% (NS) 52 (0.2%) 0.2% 0.1% (NS) No significant difference in in-hospital complication rate between groups

11 Discussion Is blanket application of screening appropriate within the realm of shoulder surgery and especially shoulder arthroplasty? OSA may not be as relevant for the shoulder surgery as it is for hip and knee surgery A diagnosis of OSA does not increase perioperative morbidity and mortality following shoulder arthroplasty Monitoring may be increased for those patients with OSA though costs do not appear higher

12 Limitations NIS does not take into account other preoperative factors or other clinical concerns Considerations such as mortality upon discharge are not accessible in this model NIS relies on clinical coding and entering diagnoses so under coding or diagnosing may alter results Patients who have this diagnosis may have greater access to medical care and take better care of themselves

13 Conclusion This study does not support OSA as a significant risk factor for in-hospital morbidity and mortality following shoulder arthroplasty Patients with OSA have a shorter relative length of stay and no increased in hospital costs following shoulder arthroplasty Further research is warranted to optimize outcomes while keeping screening costs down

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