Impact of COPD-OSA Overlap Syndrome on Outcomes of Total Hip Arthroplasty: A Propensity Score Analysis of the US National Inpatient Sample.

OBJECTIVES

Chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) together is known as overlap syndrome. This study evaluated whether overlap syndrome is associated with worse inpatient outcomes after total hip arthroplasty (THA) compared with COPD alone.

METHODS

Adult patients (≥18 years) with COPD undergoing elective THA were identified from the National Inpatient Sample database. Propensity-score matching (PSM) balanced baseline differences between patients with COPD-OSA overlap syndrome and those with COPD alone. Regression analyses evaluated in-hospital mortality, length of hospital stay, unfavorable discharge, and postoperative complications.

RESULTS

After PSM, 25,926 patients were included. Compared with COPD alone, patients with COPD-OSA overlap had higher rates of unfavorable discharge (36.0% vs 29.7%), respiratory failure (3.6% vs 1.7%), and acute kidney injury (AKI) (6.3% vs 3.8%). In adjusted analyses, COPD-OSA overlap was significantly associated with higher risks of unfavorable discharge (aOR = 1.10, 95% CI: 1.03, 1.18), respiratory failure (aOR = 1.65, 95% CI: 1.37, 1.99), and AKI (aOR = 1.18, 95% CI: 1.03, 1.35). Age-stratified analyses demonstrated increased respiratory risk in patients ≥70 years, whereas younger patients had higher risks of both respiratory failure and AKI.

CONCLUSION

Among patients undergoing elective THA, COPD-OSA overlap syndrome is associated with increased adverse inpatient outcomes.