Complications and Readmissions After Total Hip Replacement in Octogenarians and Nonagenarians

Yohe, Nicholas; Weisberg, Miriam D.; Ciminero, Matthew; Mannino, Angelo; Erez, Orry; Saleh, Ahmed

doi:10.1177/2151459320940959

Cited by 12 publications

(9 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The literature on early outcomes of nonagenarians undergoing TJA is conflicting. Some studies report that elderly patients experience high complication rates following total hip arthroplasty (THA) [3,16] and total knee arthroplasty (TKA) [6,16,17], whereas others have found that such risks were low [2] and concluded that old age alone should not prevent patients from undergoing TJA if comorbidities are assessed and addressed [1,7,8]. Methodological limitations to previous studies include using 30-day follow-up data [6,16,17], not using controls [2,3,16], or grouping nonagenarians with patients of other decades prior to analysis [16,17].…”

Section: Introductionmentioning

confidence: 99%

Nonagenarians and Octogenarians Undergoing THA and TKA: A 10-Year Age Difference Increases Rates of In-Hospital Complications But Does Not Affect 90-Day Outcomes

Fleisher

Ong

Chiu

et al. 2022

HSS Journal®: The Musculoskeletal Journal of Hospital for Speci

View full text Add to dashboard Cite

Background: The population of nonagenarians undergoing total joint arthroplasty (TJA) of the hip or knee is expected to increase, but this population may be reluctant to consider elective surgery because of their advanced age. Purpose: We sought to compare TJA outcomes between nonagenarians and octogenarians with an exact 10-year age difference. Methods: We performed a retrospective chart review, including 129 nonagenarians who underwent primary unilateral TJA for osteoarthritis in a 4-year period at a single institution and who were matched with 381 octogenarians based on sex, body mass index, Charlson Comorbidity Index, replaced joint (hip or knee), and a 10-year age difference. Ninety-day outcomes included Centers for Medicare and Medicaid Services (CMS) defined complications, unscheduled outpatient clinic visits, emergency room (ER) visits, and readmissions. No patients were lost to follow-up. Results: Nonagenarians and octogenarians had comparable rates of CMS complications (10% vs 6.3%, respectively), but nonagenarians had higher rates of CMS mechanical complications (6.2% vs 1.6%). There was 1 death in each group. Nonagenarians had longer hospital stays than octogenarians (4.1 vs 3.0 days, respectively), and a greater risk of in-hospital events and complications (60.5% vs 37.3%, respectively). The groups showed similar rates of unscheduled outpatient visits (14.7% vs 13.9%, respectively), ER visits (12.4 vs 6.6%, respectively), and readmissions (6.2% vs 7.1%, respectively). Conclusions: This retrospective study found higher rates of in-hospital complications in nonagenarians than in matched octogenarians following elective TJA, although the 2 groups showed similar rates of postdischarge complications. Further research in a larger cohort is needed.

show abstract

Section: Introductionmentioning

confidence: 99%

Nonagenarians and Octogenarians Undergoing THA and TKA: A 10-Year Age Difference Increases Rates of In-Hospital Complications But Does Not Affect 90-Day Outcomes

Fleisher

Ong

Chiu

et al. 2022

HSS Journal®: The Musculoskeletal Journal of Hospital for Speci

View full text Add to dashboard Cite

show abstract

“…It has previously been reported that THA is a safe procedure for nonagenarians, with no increased rates of complications 8 . In contrast, other studies have shown that the risk of complications increases with age 5,9,10 . These results may be contradictory because most previous studies investigated small patient cohorts and thus were underpowered.…”

mentioning

confidence: 70%

“…Previous studies have suggested that age alone may be an independent risk factor for postoperative mortality and morbidity 3 . Nevertheless, the increased risk of complications and mortality within the elderly population may be confounded by preexisting comorbidities and frailty 4,5 .…”

mentioning

confidence: 99%

Is Elective Total Hip Arthroplasty Safe in Nonagenarians?

Leopold,

Krull,

Hardt

et al. 2023

Journal of Bone and Joint Surgery

View full text Add to dashboard Cite

Background: An increasing number of elderly patients are becoming candidates for elective total hip arthroplasty (THA). Conflicting results exist with regard to the safety of THA in nonagenarians. The aims of this study were to evaluate postoperative mortality and morbidity after THA in nonagenarians and underlying risk factors. We hypothesized that nonagenarians undergoing elective THA would show higher morbidity than younger patients and higher mortality than nonagenarians in the general population. Methods: This was an observational cohort study using data from the German Arthroplasty Registry (Endoprothesenregister Deutschland [EPRD]). Of 323,129 THAs, 263,967 (including 1,859 performed on nonagenarians) were eligible. The mean follow-up (and standard deviation) was 1,070 ± 641 days (range, 0 to 3,060 days). The exclusion criteria were age of <60 years at admission and nonelective THAs or hemiarthroplasties. The cohort was divided into 4 age groups: (1) 60 to 69 years, (2) 70 to 79 years, (3) 80 to 89 years, and (4) ≥90 years. Comorbidities representing independent risk factors for postoperative complications and mortality were identified via a logistic regression model. Mortality rates were compared with those from the general population with data from the Federal Statistical Office. The end points of interest were postoperative major complications, minor complications, and mortality. Results: Among the greatest risk factors for major and minor complications and mortality were congestive heart failure, pulmonary circulation disorders, insulin-dependent diabetes, renal failure, coagulopathy, and fluid and electrolyte disorders. Compared with younger groups, the risks of major and minor complications and mortality were significantly higher in nonagenarians. Mortality increased when major complications occurred. After 1 year, the survival rate in patients without a major complication was 94.4% compared with 79.8% in patients with a major complication. The mortality rates of nonagenarians in the study population were lower than those in the corresponding age group of the general population. The 1-year mortality rates at 90 years of age were 10.5% for men and 6.4% for women within the study group compared with 18.5% for men and 14.7% for women among the general population. Conclusions: Comorbidities favor the occurrence of complications after elective THA in nonagenarians and thus increase postoperative morbidity. In the case of complications, mortality is also increased. The fact that mortality is still lower than within the general population shows that this aspect can be controlled by careful patient selection and adequate preparation. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

show abstract

“…This was evident, although mean preoperative levels of hemoglobin were similar in all groups. Yohe et al recently reported elevated rates of transfusion for octogenarians undergoing THA, too [16]. Besides lower tolerance of anemia in the elderly, the indication for transfusion could have been made more frequently by the responsible physician since, for example, chronic HIV and hepatitis -possibly induced by transfusionmay not be of that much concern in geriatric patients.…”

Section: Discussionmentioning

confidence: 99%

Total hip arthroplasty in geriatric patients – a single-center experience

Anderson

Vollmann

Weißenberger

et al. 2022

SICOT-J

View full text Add to dashboard Cite

Background: As advanced age often leads to accumulating comorbidities, geriatric patients are endangered by serious events during total hip arthroplasty. This study was conducted to explore whether or not the benefit in terms of health-related quality of life (HRQoL) was comparable to younger patients. Methods: At a single academic center, 100 patients meeting the following inclusion criteria were retrospectively recruited: (1) primary arthritis of the hip leading to THA; (2) age 80 years or older at the time of surgery; (3) follow up of at least 12 months. For comparison, two further groups were recruited in the same manner, differing only in the age criterion: 100 patients aged 60–69 and 100 patients aged 70–79 at the time of hip replacement. The primary outcome was compared using the WOMAC and the EQ-5D score. The secondary outcome was determined by rates of orthopedic and non-orthopedic complications. Intragroup comparisons of the PROMS were performed by the non-parametric Wilcoxon test for paired samples. For intergroup comparisons of the PROMS, the Kruskal–Wallis-test was performed. Concerning categorial data, intergroup comparisons were performed by the Chi-Square test. The level of significance was set at 0.05. Results: Concerning the WOMAC score, neither the absolute values at 12 months after THA (p = 0.176) nor the amount of change relative to the values before surgery (p = 0.308) differed significantly between the 3 groups. Concerning the EQ-5D index the absolute values at 12 months after THA differed significantly (p = 0.008). Rates of orthopedic complications did not differ significantly (p = 0.631). Rates of non-orthopedic complications increased significantly with rising age (p = 0.033). Conclusions: Compared to younger patients, geriatric patients after THA have an equal improvement in hip-specific and general HRQoL. While rates of orthopedic complications are comparable too, non-orthopedic complications occur more frequently.

show abstract

Complications and Readmissions After Total Hip Replacement in Octogenarians and Nonagenarians

Cited by 12 publications

References 13 publications

Nonagenarians and Octogenarians Undergoing THA and TKA: A 10-Year Age Difference Increases Rates of In-Hospital Complications But Does Not Affect 90-Day Outcomes

Nonagenarians and Octogenarians Undergoing THA and TKA: A 10-Year Age Difference Increases Rates of In-Hospital Complications But Does Not Affect 90-Day Outcomes

Is Elective Total Hip Arthroplasty Safe in Nonagenarians?

Total hip arthroplasty in geriatric patients – a single-center experience

Contact Info

Product

Resources

About