Poor Sleep Quality Associated with Impaired Postoperative Outcomes and Frailty Incidence in Elderly Patients After Total Hip Arthroplasty: A Severity Matched Case-Control Study.

OBJECTIVE

This study aimed to assess the effect of preoperative sleep quality on postoperative pain, functional recovery, and weakness in THA patients and explore its interaction with other health issues.

METHODS

This retrospective case-control study included 90 patients (45 with poor sleep PSQI>5 and 45 with good sleep PSQI≤5) matched by age, sex, and the American Society of Anesthesiologists (ASA) classification. Data on sleep, hip function, pain, anxiety/depression, and weakness were collected preoperatively and 6 months postoperatively. Multiple logistic regression was used to analyze the postoperative frailty risk factors, adjusting for age, body mass index (BMI), diabetes, and osteoporosis history, with ORs and 95% CIs.

RESULTS

Patients with poor preoperative sleep quality demonstrated significantly longer hospital stays (4.79±1.47 vs 3.42±0.89 days, P<0.001) and higher pain scores at 3 months postoperatively (visual analog scale [VAS] 3.13±1.04 vs 1.87±0.87, P<0.001). Multivariate analysis identified preoperative poor sleep as an independent predictor of postoperative frailty (OR=2.44, 95% CI 0.97-4.20, P=0.002), along with age ≥65 years (OR=11.29) and osteoporosis history (OR=2.06). Two-way ANOVA revealed significant group-time interactions in PSQI scores (P<0.001). While both groups showed postoperative PSQI improvement (poor sleep: 11.89±2.92 to 6.56±2.39; good sleep: 3.31±1.57 to 2.29±1.14), between-group differences remained significant (P<0.001).

CONCLUSION

Poor preoperative sleep quality was associated with a higher risk of pain and frailty after THA, possibly due to a two-way relationship. Although this study has some limitations, preoperative sleep screening could be useful in improving perioperative care and requires further testing in future studies.