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Region Hovedstaden - en del af Københavns Universitetshospital
E-pub ahead of print

Hypoxemia following hospital discharge after fast-track hip- and knee arthroplasty-a prospective observational study subanalysis

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

DOI

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BACKGROUND: Postoperative hypoxemia is prevalent in hospitalized patients and may adversely affect recovery. However, little data exists on the post-discharge phase or details on duration, severity and potential risk factors. Thus, we investigated the incidence and risk factors for severe desaturation during the first postoperative week after THA/TKA by continuous nocturnal oxygen saturation monitoring.

METHODS: The study was a secondary analysis of a prospective cohort study of 112 patients undergoing fast-track THA/TKA. Patients with known sleep apnea were excluded. Oxygen saturation and heart rate were recorded by a wireless wrist-worn pulse oximeter two nights before- and seven nights after surgery. Data on demographics, opioid consumption and cognitive function were collected from medical charts, patient-diaries and clinical testing, respectively. The primary outcome was occurrence of severe desaturation defined as periods with saturation <85% lasting ≥10 minutes. Secondary outcomes included description of various saturation levels and relevant risk factors.

RESULTS: Severe oxygen desaturation occurred in 35% of the patients during the first postoperative week. Duration and severity of hypoxemic episodes increased after the first postoperative day. Preoperative episodes of hypoxemia significantly increased the risk of postoperative hypoxemic events (OR 2.4-4.4, CI 0.4-46), while neither pre- and postoperative opioid use, age, gender, ASA classification, type of surgery or anesthesia were significantly related to the development of postoperative hypoxemia.

CONCLUSIONS: One third of the patients suffered from increased and prolonged episodes of severe nocturnal hypoxemia during the first week after THA/TKA discharge. Increased risk for severe hypoxemic episodes was related to preoperative hypoxemia.

EDITORIAL COMMENT: It is well recognized that the perioperative period remains a challenge with for example unwanted side effects from opioids like sedation, nausea and vomiting, and respiratory depression. This study shows that nocturnal hypoxemia following major joint replacement surgery is not uncommon and is also aggravated during the first postoperative week.

OriginalsprogEngelsk
TidsskriftActa Anaesthesiologica Scandinavica
ISSN0001-5172
DOI
StatusE-pub ahead of print - 13 jul. 2020

ID: 60361813