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Abstract：
OBJECTIVE: 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.
METHODS: Retrospective analysis.
METHODS: Operating room.
METHODS: 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%).
METHODS: No intervention.
METHODS: 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.
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.
METHODS: Retrospective analysis.
METHODS: Operating room.
METHODS: 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%).
METHODS: No intervention.
METHODS: 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.
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.
摘要：
目的：探讨阻塞性睡眠呼吸暂停（OSA）患者全髋关节置换术（THA）后的预后。根据实践指南的发布，评估区域麻醉（RA）与全身麻醉（GA）的使用趋势。根据麻醉类型比较术后结局。
方法：回顾性分析。
方法：手术室。
方法：349,008名在佛罗里达州接受选择性THA的患者，纽约,马里兰,和肯塔基州在2007年至2014年之间是从州住院数据库(SID)中提取的，医疗保健成本和利用项目，包括18,063例OSA患者（5.2%）。
方法：无干预。
方法：使用双变量分析和多变量逻辑回归模型研究OSA对术后结局的影响。研究结果包括住院死亡率，术后并发症,停留时间(LOS)和出院后再入院。只有来自纽约的人口，（n=105,838，其中5306例OSA患者[5.0％]），我们根据麻醉类型调查了OSA人群的结局.对每个年度进行总体分析。
结果：OSA患病率从2007年的1.7%上升到2014年的7.1%。在多变量分析中，OSA对院内死亡率无影响(aOR:0.57;0.31-1.04).术后并发症,LOS,OSA患者的再入院率均较高。在接受GA的OSA患者中，我们发现总体并发症和肺部并发症的发生率较高,尤其是男性,女性90日再入院的发生率较高.在学习期间，OSA患者的GA使用率增加。
结论：在研究期间，接受THA的患者的OSA患病率增加了四倍。OSA与术后总并发症增加有关，LOS,和重新接纳，但不是住院死亡率。尽管发表了倾向于RA而不是GA的指南，研究期间GA的使用增加。
方法：回顾性分析。
方法：手术室。
方法：349,008名在佛罗里达州接受选择性THA的患者，纽约,马里兰,和肯塔基州在2007年至2014年之间是从州住院数据库(SID)中提取的，医疗保健成本和利用项目，包括18,063例OSA患者（5.2%）。
方法：无干预。
方法：使用双变量分析和多变量逻辑回归模型研究OSA对术后结局的影响。研究结果包括住院死亡率，术后并发症,停留时间(LOS)和出院后再入院。只有来自纽约的人口，（n=105,838，其中5306例OSA患者[5.0％]），我们根据麻醉类型调查了OSA人群的结局.对每个年度进行总体分析。
结果：OSA患病率从2007年的1.7%上升到2014年的7.1%。在多变量分析中，OSA对院内死亡率无影响(aOR:0.57;0.31-1.04).术后并发症,LOS,OSA患者的再入院率均较高。在接受GA的OSA患者中，我们发现总体并发症和肺部并发症的发生率较高,尤其是男性,女性90日再入院的发生率较高.在学习期间，OSA患者的GA使用率增加。
结论：在研究期间，接受THA的患者的OSA患病率增加了四倍。OSA与术后总并发症增加有关，LOS,和重新接纳，但不是住院死亡率。尽管发表了倾向于RA而不是GA的指南，研究期间GA的使用增加。
