Effects of obstructive sleep apnea on postoperative outcomes following total knee arthroplasty: A matched cohort analysis

Obstructive sleep apnea (OSA), linked to inflammation, hypercoagulability, and poor wound healing, may affect orthopedic surgical outcomes. Though recognized as a perioperative risk in general and cardiac surgeries, its impact on total knee arthroplasty (TKA) is not well defined. This study examines the association between OSA and postoperative complications following TKA in a large real-world cohort. This retrospective cohort study used the PearlDiver Mariner Database to identify TKA patients from 2010 to 2021. Patients with preoperative OSA were matched to controls based on CCI and other relevant comorbidities. Postoperative outcomes including thromboembolic events, surgical site infections (SSI), acute kidney injury (AKI), transfusion requirements, reoperations, and readmissions, were compared between groups using multivariate logistic regression to adjust for confounders. Among 421,304 TKA patients, 50 % (n = 210,652) had OSA. OSA was associated with a higher prevalence of comorbidities, including COPD (15.1 % vs. 12.4 %, p < 0.001), obesity (32.3 % vs. 22.0 %, p < 0.001), and hypertension (68.1 % vs. 63.7 %, p < 0.001). Patients with OSA had an increased risk of DVT (0.7 % vs. 0.5 %; OR: 1.37, p < 0.001), SSI (0.6 % vs. 0.5 %; OR: 1.24, p < 0.001), and wound disruption (1.1 % vs. 1.0 %; OR: 1.07, p = 0.020). However, OSA was associated with lower rates of AKI (2.0 % vs. 2.1 %; OR: 0.95, p = 0.016) and transfusion (1.3 % vs. 2.1 %; OR: 0.59, p < 0.001). Readmission rates were higher in the OSA cohort (1.3 % vs. 1.1 %; OR: 1.27, p < 0.001). OSA is an independent risk factor for thromboembolic and infectious complications after TKA, but is paradoxically linked to lower rates of AKI and transfusion. These findings underscore the need for improved perioperative management and surveillance in OSA patients. Future studies should explore the roles of OSA severity and CPAP adherence.