There is No Increased Pulmonary Risk Following Total Hip Arthroplasty in Patients Who Have Obstructive Sleep Apnea Without Underlying Lung Disease

Background: Obstructive sleep apnea (OSA) is a frequent comorbidity. The current study evaluated whether there is a difference in the perioperative outcome after total hip arthroplasty (THA) in patients who had a low to moderate risk for OSA and high risk for OSA, respectively.

Methods: After excluding patients who had concomitant lung disease (chronic obstructive pulmonary disease, asthma, or lung fibrosis) and those missing a STOP-Bang Score, 1,141 THA patients who had OSA were included in this retrospective study. Patients at low to moderate risk for OSA (STOP-Bang Score 0 to 4) and patients at high risk for OSA (STOP-Bang Score 5 to 8) were compared, and SpO₂ (oxygen saturation) drops < 90% as well as readmission rates were compared between patients who did and did not use continuous positive airway pressure (CPAP).

Results: There was no difference in the risk of SpO₂ drop below 90% (1 versus 0%, P = 0.398) and readmission rate (2 versus 2%, P = 0.662) between patients who had low to moderate OSA risk (327 THA) and high OSA risk (814 THAs). There was no difference in SpO₂ (P > 0.999) and a decrease in oxygen flow rate from the postanesthesia care unit to the morning of the first postoperative day. A CPAP device was used by 41% (467 of 1,141) of patients. There were no differences in SpO2 drop < 90% (0 versus 0%, P = 0.731) and readmission rate (2 versus 2%, P = 0.612) between patients who did and did not use a CPAP machine.

Conclusions: The current study showed no difference in perioperative outcomes between OSA patients undergoing THA who had a low STOP-Bang Score and patients who had a high STOP-Bang Score, regardless of the use of a CPAP machine. These data suggest that an elevated Stop-Bang Score does not indicate an increased perioperative risk for OSA patients when deciding on outpatient discharge.