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

Abstract

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.

Total Hip Arthroplasty in Nonagenarians – A National In-Patient Sample-Based Study of Perioperative Complications

“…2,10 The longer hospital stay is attributed to many factors, not just the higher perioperative complications. 5,9,12 Our data confirmed previously reported data on the higher cost of care (COC) in this patient population. Fang et al, reported that nonagenarians had significantly higher implant and total-in-hospital costs for total joint arthroplasty in comparison to octogenarians.…”

“…2 Nonagenarians are at a greater risk of perioperative complications. 9 Previous studies have demonstrated a higher risk of complications following THAs. 2,5,12,13 The nonagenarians are often with medical co-morbidities, some of which may not be modifiable before or after THAs.…”

“…8 Other studies have reported THA and total knee arthroplasty (TKA) in this population are associated with increased hospital costs, increased length of stay (LOS), and higher complication rates. 9,10 The purpose of this study was to query a large patient database (the Nationwide Inpatient Sample (NIS) Database) to evaluate the patient characteristics, demographics, and incidence of postoperative complications among nonagenarian patients who underwent primary THAs. We hypothesize that the nonagenarians will have higher rates of perioperative complications, longer hospitalization, and higher costs associated with their care.…”

A comprehensive analysis of age and 30-day complications following total shoulder arthroplasty: nonagenarians, octogenarians, and septuagenarians

“…Prior studies on joint replacement surgery among older patients compared to younger patients have reported increased risk of multiple medical complications, longer hospital stays, readmission, and mortality. 4 , 9 , 10 , 11 , 19 , 21 However, understanding how each increased decade of life affects adverse outcomes has not been explored. Further investigation to stratify postoperative outcomes within older age groups may help to better understand as to which adverse outcomes certain patient groups are at higher risk.…”