The association of existing home preoperative continuous positive airway pressure therapy for obstructive sleep apnea with the incidence of early emergency department visits after outpatient total hip and knee arthroplasty.

PURPOSE: To assess the association of home preoperative continuous positive airway pressure therapy (CPAP) and the incidence of emergency department (ED) visits for obstructive sleep apnea (OSA) patients undergoing outpatient total hip and knee arthroplasty (THA, TKA).

METHODS

This retrospective cohort study (Merative MarketScan, 2018-2022) included adults undergoing outpatient THA (n = 45,101) and TKA (n = 78,248). We grouped OSA patients with (OSA+/CPAP+) or without preoperative CPAP (OSA+/CPAP-) therapy and patients without OSA (OSA-). Outcomes were any ED visit within postoperative day 1 (POD 1) or 7 (POD 7). Using pairwise mixed-effects regression models we reported odds ratios (OR) and 95% confidence intervals (CI).

RESULTS

After adjustment, ORs for POD 1 ED visits were not significant among THAs. Among TKAs, for the same outcome, OSA+/CPAP+ had lower odds than OSA+/CPAP- (OR 0.76, 95% CI 0.62-0.94) and OSA+/CPAP- had higher odds than OSA- (OR 1.22, 95% CI 1.05-1.42). For ED visits within POD 7, OSA+/CPAP+ versus OSA+/CPAP- ORs were: THA OR 0.78, 95% CI 0.62-0.99 / TKA OR 0.84, 95% CI 0.74-0.96; OSA+/CPAP- versus OSA- ORs were: THA OR 1.27, 95% CI 1.08-1.49 / TKA OR 1.24, 95% CI 1.12-1.38. No differences were observed between OSA+/CPAP+ and OSA- patients.

CONCLUSION

OSA without existing preoperative CPAP therapy was independently associated with increased odds of post-outpatient THA and TKA ED visits. There was no difference in post-outpatient THA and TKA ED visits between patients with OSA who used CPAP preoperatively and those without OSA, suggesting that CPAP mitigates risk. These findings support current guidelines and may warrant caution among outpatients with OSA that are not on CPAP preoperatively.