Outcomes after total shoulder arthroplasty in obstructive sleep apnea patients: a retrospective cohort analysis of over 10,000 patients.

INTRODUCTION

Obstructive sleep apnea (OSA) impacts postoperative outcomes in orthopedic procedures. This study compared complications between total shoulder arthroplasty (TSA) patients with and without OSA.

METHODS

We queried the Nationwide Readmission Database (2020-2022) for primary reverse or anatomic TSA patients. Cohorts were identified by OSA diagnosis and propensity score matched for age, BMI, Charlson Comorbidity Index, and sex. Outcomes included 90-day composite complication rates (pulmonary, cardiovascular, surgical), length of stay (LOS), and 30/90-day readmissions.

RESULTS

The analysis included 10,290 patients (5,145 OSA, 5,145 non-OSA; mean age 66.5 ± 9.0 years). On multivariate analysis, OSA was associated with increased risk of 90-day composite complications (OR: 1.84; 95% CI 1.51-2.23; p < 0.001) and pulmonary complications (OR: 2.17; 95% CI 1.74-2.71; p < 0.001). OSA patients also experienced longer LOS (OR: 1.12; p = 0.001). The adjusted predicted complication probability was 5.62% for OSA vs. 3.13% for non-OSA. OSA patients had no significant difference for adjusted 30-day (OR: 0.74; p = 0.386) and 90-day (OR: 0.72; p = 0.561) readmission rates.

CONCLUSION

Patients with OSA undergoing TSA face a significantly increased risk of 90-day postoperative complications and longer hospital stays. Shoulder surgeons and anesthesiologists should implement enhanced perioperative protocols to evaluate and optimize OSA patients undergoing TSA.