The Effect Of Preoperative Sleep Quality On Early Recovery After Primary Total Knee Arthroplasty Under Enhanced Recovery After Surgery :a Prospective Cohort Study.

ObjectiveTo investigate the effect of preoperative sleep quality on early recovery after primary total knee arthroplasty under enhanced recovery after surgery.MethodsThis is a prospective cohort study,from November 2016 to May 2018,a total of 302 patients undergoing primary TKA who meet the inclusion criteria were enrolled in the study from department of orthopaedics of the first affiliated hospital of Anhui medical university.they were grouped according to the score of preoperative sleep quality(using the Pittsburgh Sleep Quality Index),124 cases were included in the high sleep quality group(HSQG)with a score of less than 7 points,while a total of 178 cases of low sleep quality group(LSQG)with a score greater than or equal to 7 points.There were 56 males and 68 females in the high sleep quality group,average(65.840±6.640)years,while 70 males and 108 females in the low sleep quality group,average(65.190±7.825)years.The two groups of patients were implemented the same perioperative nursing which guided by the concept of enhanced recovery after surgery(ERAS)The outcomes including the resting state VAS(Visual Analogue Scale,VAS)pain score postoperative 24 h and 72h;postoperative hospital stays;the number of days required for 90 degree of knee flexion;POD3 SCL-90 scores and patients satisfaction(using Likert Scale)were observed.COX proportional hazards model was used to analyze the association between preoperative sleep quality and postoperative hospital stays.ResultsThere was no significant difference in preoperative baseline data such as gender,age,body mass index and HSS score of knee joint between the two groups(P > 0.05).Compared to the LSQG group,the resting state VAS pain scores postoperative 24h[(3.620±+0.593)vs(3.850±0.740)] and 72h[(2.170±0.472)vs(2.370±0.528)],postoperative hospital stays[(6.270±1.120)d vs(6.870±1.478)d],the number of days required for 90 degree of knee flexion[(2.990±0.727)d vs(3.370±0.868)d],the anxiety[(15.240±1.783)vs(16.560±2.136)] and depression[(11.980±1.338)vs(13.240±1.562)] scores POD3 were lower in the HSQG group,the difference was statistically significant(P<0.05).In HSQG group,the hospitalization satisfaction [(3.863±0.810)vs(3.663±0.863)] was higher than that in LSQG group,and the difference was statistically significant(P<0.05).The sleep quality was classified as a categorical variable,the results showed that length of hospital stays in HSQG group was 0.677 times that in LSQG group(95% confidence interval: 0.529-0.866).ConclusionsThe patients with better preoperative sleep quality had lower postoperative pain,shorter number of days required for 90 degree of knee flexion and postoperative hospitalization days,lower postoperative depression and anxiety,and higher hospitalization satisfaction.Therefore,high preoperative sleep quality can accelerate early recovery after TKA operation under enhanced recovery after surgery.