Primary ArthroplastyComplications and Mortality Following Total Hip Arthroplasty in the Octogenarians: An Analysis of a National Database
Section snippets
Materials and Methods
We retrospectively queried the American College of Surgeons-National Surgical Quality Improvement Program (NSQIP) database for all patients who underwent primary, elective THA from January 1, 2011 to December 31, 2014. Patients in the database were identified based on the primary procedure consisting of Current Procedural Terminology code 27130. Revision arthroplasty, conversion THA, and THA with procedural codes for fractures were excluded from the study. This study was exempt from
Results
Of the total 66,839 patients included in the study, there were 7198 patients ≥80 years old (11%). The mean age of all patients was 64.7 (standard deviation 11.6) and 29,495 (44%) patients were male. For all patients there were 11,117 (17%) complications, 352 (0.5%) readmissions, and 147 (0.2%) deaths within 30 days. Descriptive statistics of the study population are tabulated in Table 1. The octogenarian group had a lower percentage of men (35% vs 45%, P < .001). The octogenarian group also had
Discussion
Although implementation of efficient clinical pathways and improved anesthesia and rehabilitation protocols have made arthroplasty in elder populations a reality, concerns exist about whether these patients can safely undergo major orthopedic surgeries such as total joint replacements [10], [13], [14], [15]. With improvements in medicine and the advancing age of our population, people are living longer and healthier lives. According to the 2015 US census, the elderly (>65 years old) are now
Conclusions
THA in the elderly still poses a relatively high risk of short-term postoperative complications and mortality. In the hospital setting with sufficient resources to manage complications, elderly arthroplasty may be an option. Sufficient counseling regarding increased rates of complications and mortality should be included in the preoperative evaluation in this population, particularly with complex comorbidities such as kidney disease and malnourishment. In the preoperative discussion with
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Cited by (21)
Malnutrition is associated with postoperative complications in elderly patients undergoing total hip arthroplasty
2023, Endocrinologia, Diabetes y NutricionCitation Excerpt :These conditions increase the likelihood of postoperative complications, prolonged recovery and increased mortality. Furthermore, observational studies have shown that malnutrition and advanced age in patients undergoing THA are early predictors of mortality.2,3 Moreover, 37% of patients with hip fractures have sarcopenia, which also makes rehabilitation more difficult.4
Elective Total Hip Arthroplasties in Nonagenarians—Age Does Matter: A National Surgical Quality Improvement Program Study
2022, Journal of ArthroplastyCitation Excerpt :Alfonso et al [2] reported a rate of 9/25 (32%) cardiac complications for comorbid patients. Boniello et al [20] found higher preoperative rates of kidney (6%) and heart disease (1%), while Joshi and Gill [21] correlated cardiac risk factors with increased postoperative mortality and morbidity. In our study, a higher proportion of nonagenarians reported MI, cardiac arrest, and unplanned intubation during the first 30 days following surgery.
The Association Between Comorbidity and the Risks and Early Benefits of Total Hip Arthroplasty for Hip Osteoarthritis
2020, Journal of ArthroplastyCitation Excerpt :Comorbid diseases are conditions that are unrelated in etiology to the condition of interest [21], in this case, osteoarthritis of the hip. In the present study, we showed that comorbidity, as measured by either the ASA grade or CCI, was significantly associated with the incidence of perioperative/short-term postoperative complications, with the odds of a complication being almost twice as great for ASA ≥3 as for ASA <3, similar to the figure (OR 2.109) reported for 30-day complications by Boniello et al [28]. In the present study, however, we showed that comorbidity was not only associated with a higher likelihood of complications but also—and independently—with a somewhat poorer patient-rated outcome.
Impact of Chronic Kidney Disease in Older Adults Undergoing Hip or Knee Arthroplasty: A Large Database Study
2020, Journal of ArthroplastyCitation Excerpt :To varying degrees, the research supporting an association between CKD and adverse postoperative outcomes in arthroplasty patients has focused on advanced CKD [5,18,21,36–40]. For instance, a retrospective analysis of octogenarians undergoing hip or knee arthroplasty found that CKD was an independent predictor of mortality [23]. For the purpose of that study, CKD was defined as a SCr >1.5 mg/dL.
Total hip arthroplasty for hip fractures in patients older than 80 years of age: a retrospective matched cohort study
2023, Archives of Orthopaedic and Trauma Surgery
Source of Funding: No outside finding was received for this study.
No author associated with this paper has disclosed any potential or pertinent conflicts which may be perceived to have impending conflict with this work. For full disclosure statements refer to https://doi.org/10.1016/j.arth.2017.08.030.
Study conducted at Rush University Medical Center, Chicago, Illinois.
Disclaimer: The American College of Surgeons National Surgical Quality Improvement Program and the hospitals participating in the American College of Surgeons National Surgical Quality Improvement Program are the source of the data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.