Evaluating the Safety of Prescription Sleep Medications in Patients Undergoing Total Knee Arthroplasty: A Propensity Matched Analysis.

Abstract

Impaired sleep is reported in over 50% of patients after a total knee arthroplasty (TKA). Clinicians often treat postoperative sleep disturbances with medications; however, the risks associated with the use of sleep medications after TKA are not well understood. We assessed the association between sleep medication use after TKA and postoperative complications. Using a national administrative claims database, we identified 101,806 patients undergoing primary TKA from 2011 to 2022 who were taking sleep medications within 90 days after surgery and 509,030 patients who were not, which formed the control group. We further analyzed the effects of standard prescription sleep medications (daridorexant, eszopiclone, lemborexant, suvorexant, temazepam, triazolam, zaleplon, zolpidem) and less potent prescription sleep medications (doxepin, ramelteon). Ninety-day and 365-day outcomes investigated were falls, revision surgery, dislocation, fractures, and emergency department (ED) visits. Multivariable logistic regressions were used to calculate odds ratios, adjusting for age, sex, region, insurance plan, Elixhauser Comorbidity Index, preoperative sleep medication usage, and history of mood and anxiety disorders. Use of any sleep medication was associated with an increased risk of 90-day prosthetic joint dislocations (OR, 1.26; 95% CI, 1.02 to 1.54; P = 0.031), revision surgery (OR, 1.12; 95% CI, 1.02 to 1.24; P = 0.019), falls (OR, 1.10; 95% CI, 1.03 to 1.18; P = 0.008), and ED visits (OR, 1.12; 95% CI, 1.09 to 1.15; P < 0.001). Standard sleep medication usage was correlated with an increased risk of 90-day and 365-day revision surgery, falls, distal radius fractures, and ED visits (P < 0.05). Use of any prescription sleep medication or only standard sleep medications is associated with increased surgical complications. Additional research is needed to find medications that may be safer for routine postoperative use.