Primary Arthroplasty
Complications and Mortality Following Total Hip Arthroplasty in the Octogenarians: An Analysis of a National Database

https://doi.org/10.1016/j.arth.2017.08.030Get rights and content

Abstract

Background

As advances in medicine have increased life expectancy, more octogenarians are undergoing total hip arthroplasty (THA) than ever before. Concerns exist, however, about the safety of performing this elective procedure in this age group. The purpose of this study is to determine the 30-day complications associated with THA patients over 80 years of age and to identify high-risk patients.

Methods

We queried the American College of Surgeons-National Surgical Quality Improvement Program database for all patients who underwent primary THA from 2011 to 2014. Demographic variables, medical comorbidities, and 30-day complication, readmission, and reoperation rates were compared between patients under vs over 80 years of age. A multivariate logistic regression analysis was then performed to identify independent risk factors of poor short-term outcomes.

Results

Of the total 66,839 patients who underwent THA, 7198 (11%) patients were 80 years of age or older. Octogenarians had a higher overall complication rate (29% vs 15%, P < .001) and a higher mortality rate (0.9% vs 0.1%, P < .001). When controlling for other comorbidities, age over 80 years is an independent risk factor for mortality (odds ratio 2.02, 95% confidence interval 1.25-3.26, P = .004) and complications (odds ratio 1.41, 95% confidence interval 1.30-1.525, P < .001) following THA. Malnutrition and chronic kidney disease are also independent risk factors for readmission, complications, and mortality (all P < .05).

Conclusion

THA in patients older than 80 years old are at an increased risk of complications and mortality. Octogenarian patients should be counseled on their risk profile, particularly those with malnutrition and chronic kidney disease.

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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    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.

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