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

Obstructive sleep apnea (OSA) is a common but often underrecognized risk factor for perioperative complications. While OSA has been associated with increased morbidity following general and cardiac surgery, its impact on total hip arthroplasty (THA) outcomes remains insufficiently characterized. This study aimed to evaluate the influence of OSA on postoperative complications following THA. A retrospective cohort analysis was conducted using the PearlDiver Mariner Database, identifying patients who underwent primary THA between 2010 and 2021. Patients with a preoperative diagnosis of OSA were matched to controls without OSA based on age, sex, CCI, diabetes, obesity, tobacco use, alcohol use, coagulopathy, coronary artery disease, osteoarthritis. Baseline demographics, comorbidities, and postoperative complications were compared. Multivariate logistic regression models were used to adjust for potential confounders, including comorbidity burden as quantified by the Charlson Comorbidity Index (CCI). Of the 171,640 studied THA patients, 50 % (n = 85,820) had OSA. OSA was associated with higher rates of surgical site infection (0.7 % vs. 0.6 %; OR: 1.23, p < 0.001), deep vein thrombosis (0.6 % vs. 0.5 %; OR: 1.32, p < 0.001), and wound disruption (1.1 % vs. 0.9 %; OR: 1.22, p < 0.001). Patients with OSA had an increased risk of revision THA (2.9 % vs. 2.6 %; OR: 1.09, p = 0.002) and periprosthetic joint infection (1.0 % vs. 0.7 %; OR: 1.38, p < 0.001). However, OSA was associated with lower transfusion rates (1.7 % vs. 2.7 %; OR: 0.64, p < 0.001). Despite these differences, overall complication rates were similar (12.7 % vs. 13.0 %; OR: 0.96, p = 0.022). OSA is associated with an elevated risk of infection-related complications, venous thromboembolism, and revision surgery following THA, highlighting the need for enhanced perioperative management strategies. These results underscore the importance of preoperative OSA screening and individualized perioperative care protocols to optimize outcomes in THA patients with OSA.