Is Preop Home Oxygen Linked to PostOp TKA Complications?

Who would think that some extra oxygen before surgery could be harmful? A team of the University of Virginia (UVA) did. Their study, “Use of Supplemental Home Oxygen is Associated with Early Postoperative Complications Following Total Knee Arthroplasty,” is published in the May 31, 2022, edition of The Journal of Arthroplasty.

“As a tertiary care center,” said co-author James A. Browne, M.D. to OTW, “we were seeing patients referred to us for total knee arthroplasty [TKA] who had severe respiratory disease and required supplemental oxygen at home. We recognized there was no data in the literature to help guide the discussion about the risks of surgery in this patient population.”

The Division Head of Adult Reconstruction at UVA, Dr. Browne added, “Our recommendations to these patients were not based on solid evidence. We knew these patients were high risk for complications, but just how high we didn’t know. So, we set out to investigate that further.”

Using a national database, the researchers looked at patients with respiratory disease who underwent elective TKA from 2010 to 2020, looking at different variables by those used supplemental home oxygen and those who did not.

“In order to zero in on the use of supplemental home oxygen use,” commented Dr. Browne to OTW, “we compared these patients to two matched cohorts: patients without respiratory disease, and patients with respiratory disease that did not use supplemental oxygen at home. A fairly sophisticated method using multiple supply codes for medical equipment was used to ensure the study patients were indeed using oxygen.”

The team looked at 41,418 patients with respiratory disease who underwent TKA and who used home oxygen and 138,635 TKA patients who had respiratory disease but did not use home oxygen, comparing them with matched cohorts.

They found that patients with respiratory disease on home oxygen had a significantly higher incidence of periprosthetic joint infection (5.78% versus 2.69%, pneumonia (3.95% versus 0.69%, venous thromboembolism (3.17% versus 2.10%, and periprosthetic fracture (0.82% versus 0.34%) compared to the matched control cohort.

They also determined that the respiratory disease patients on home oxygen had a significantly higher incidence of periprosthetic joint infection (5.78% versus 3.77%) pneumonia (3.95% versus 1.63%), and additional medical complications compared to respiratory disease patients without home oxygen use.

“Not unexpectedly, patients on home oxygen have risks that far exceeded that of a matched population without respiratory disease,” Dr. Browne told OTW. “However, the additional risk of oxygen use was present but not dramatically higher when compared to a matched cohort with respiratory disease (odds ratios were consistently less than 2).”

“This study was a large administration database study which comes with unavoidable limitations. One should be cautious when using one single observational study like this to guide practice. We did find an association between home oxygen use and a significantly higher risk of surgical and medical complications following elective total knee arthroplasty. However, our data failed to show a dramatically higher rate of complications in patients on home oxygen compared to patients with respiratory disease not on home oxygen. Patients with respiratory disease are high risk for complications, but the presence or absence of home oxygen in these patients does not appear to have a major association with outcomes.”