Poor Sleep Quality Associated with Impaired Postoperative Outcomes and Frailty Incidence after Total Hip Arthroplasty: A Severity Matched Case-control Study

Objective Sleep quality of patients has a complex association with postoperative total hip arthroplasty (THA), yet its impact on recovery of hip function and frailty occurrence is still not uniformly recognized. The purpose of this study is to assess the impact of preoperative sleep quality on the prognosis of patients undergoing a first-time THA and its relationship to chronic pain, anxiety, depression, and frailty. Methods In this project, 45 patients each with good and poor sleep quality who underwent THA for the first time were included according to the PSQI index, with PSQI index surpassing 5 considered as poor sleep quality. Patients in the study group and the control group were matched according to their age, gender and American Society of Anesthesiologists (ASA) scores, and intra-operative complications, blood loss, surgery duration, postoperative analgesic use, and length of hospital stay were analyzed. Also, changes of sleep quality, HHS index, pain value, anxiety, depression and frailty occurrence were compared before and 6 months after surgery. The demographics of the comparison cohorts were analyzed by paired t-tests or paired Wilcoxon signed-rank tests, and independent t-tests and nonparametric tests were adopted to screen risk factors of postoperative frailty. Multivariate logistic regression analysis was introduced for independent risk factors calculation. A p-value less than 0.05 was considered as statistically significance. Results Poor sleep quality was associated with poorer recovery, including longer postoperative hospitalization after THA, more pronounced chronic pain 3 months after surgery, higher anxiety, depression index and frailty index 6 months after surgery. Older age, diabetes, osteoporosis, BMI lower than the normal and poor sleep quality were potential factors of postoperative frailty, among which poor sleep quality represented an independent risk factor related to postoperative frailty. Conclusions Poor sleep quality registers association with postoperative frailty after THA, emphasizing the importance of preoperative identification for patients, which may guide clinicians in developing perioperative strategies and provide patients with potential risks.