Outcomes of Elective Total Hip Arthroplasty in Nonagenarians and Centenarians

Sherman, Alain E.; Plantz, Mark A.; Hardt, Kevin D.

doi:10.1016/j.arth.2020.03.026

Cited by 16 publications

(13 citation statements)

References 45 publications

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“…More recent studies such as that by Sherman et al indicated that nonagenarians are not at increased risk of medical complications after THA compared with a comorbidity-matched cohort of younger patients. 18 By contrast, Dagneaux et al found that nonagenarians had considerable mortality rates at 90 days (6%) and 1 year (8%) and high incidences of medical complications, thus reaffirming older studies. 19 Our study found a 33% incidence of medical complications, which was a decrease from prior findings of Pagnano et al, who demonstrated a 40% medical complication rate.…”

Section: Discussionmentioning

confidence: 91%

Hip and Knee Arthroplasty Outcomes for Nonagenarian Patients

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Copp

et al. 2022

J Am Acad Orthop Surg

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Introduction: Studies have previously reported higher complication rates in elective total joint arthroplasty (TJA) for nonagenarians compared with younger cohorts. The purpose of this study was to assess whether nonagenarians were still at increased risk of complications and hospital readmissions by answering three questions: (1) Do nonagenarians have an increased risk of medical complications after TJA compared with octogenarians and septuagenarians? (2) Do nonagenarians have an increased risk of surgical complications after TJA compared with octogenarians and septuagenarians? (3) Do nonagenarians have an increased risk of hospital readmission after TJA compared with octogenarians and septuagenarians?Methods: A total of 174 patients undergoing primary TJA between 2010 and 2017 were included; 58 nonagenarians (older than 90 years) were matched with 58 octogenarians (age 80 to 84 years) and 58 septuagenarians (age 70 to 74). Groups were matched by sex, diagnosis, surgeon, surgical joint, and year of surgery. Within each group, 31 patients (53%) underwent total hip arthroplasty and 27 patients (47%) underwent total knee arthroplasty. Comorbidities, American Society of Anesthesiologists physical status scores, and Charlson Comorbidity Index scores were captured preoperatively. Complications and readmissions occurring within 90 days postoperatively were evaluated.Results: Nonagenarians had the highest rate of medical complications (33%) compared with octogenarians (14%) and septuagenarians (3%) (P , 0.001). Rates of surgical complications were not statistically different among nonagenarians (12%), octogenarians (9%), and septuagenarians (10%) (P = 0.830). Rates of hospital readmission were highest in nonagenarian patients (11%), but not statistically different compared with octogenarians (5%) or septuagenarians (2%) (P = 0.118).

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Section: Discussionmentioning

confidence: 91%

Hip and Knee Arthroplasty Outcomes for Nonagenarian Patients

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Bugbee

Copp

et al. 2022

J Am Acad Orthop Surg

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“…It has been shown that total hip arthroplasty remains a safe and viable treatment modality in patients over 90 years old (nonagenarians). 35 Another study analyzed risks specific to nonagenarians undergoing elective total joint arthroplasty and recommended that while comorbidities did not differ significantly between nonagenarians and younger patients, complications, including longer mean length-of-stay and higher readmission rate, were more characteristic of this cohort and needed to be addressed in a shared preoperative decision-making process. 36 Further studies on elderly patients undergoing primary knee arthroplasty and lumbar spine surgery found similar trends in these complications and highlighted the role of the low BMI and decreased functional status as risk factors.…”

Section: Discussionmentioning

confidence: 99%

Increased 30-Day Postoperative Readmission and Medical Complication Rates Among Patients 65 Years and Older Following Arthroscopic Rotator Cuff Repair

Plantz

Gerlach

et al. 2022

Arthroscopy, Sports Medicine, and Rehabilitation

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“…The ACS NSQIP have implemented regular auditing procedures that have yielded data with excellent reliability that has continued to improve over time [11]. Additionally, the database has been utilized extensively to identify the incidence of and risk factors for a variety of short-term complications following a variety of orthopaedic procedures [12][13][14].…”

Section: Data Sourcementioning

confidence: 99%

Determining the incidence and risk factors for short-term complications following distal biceps tendon repair

Goedderz

Plantz

Gerlach

et al. 2022

Clin Shoulder Elbow

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Background: Distal biceps rupture is a relatively uncommon injury that can significantly affect quality of life. Surgical repair has the potential to provide functional improvement for patients. However, early complications following biceps tendon repair are not well described in the literature. This study aims to utilize a verified national surgical database to determine the incidence of and predictors for various short-term complications following distal biceps tendon repair. Methods: The American College of Surgeons’ National Surgical Quality Improvement Program database was used to identify patients undergoing distal biceps repair between January 1, 2011, and December 31, 2017. Patient demographic variables of sex, age, body mass index (BMI), American Society of Anesthesiologists class, functional status, and several comorbidities were reported for each patient, along with various 30-day postoperative complications. Binary logistic regression was used to calculate risk ratios for these complications using patient predictor variables.Results: Early postoperative overall surgical complications (0.5%)—which were mostly infections (0.4%)—and overall medical complications (0.3%) were rare. A risk factor for readmission was diabetes (risk ratio [RR], 4.238; 95% confidence interval [CI], 1.180–15.218). Risk factors for non-home discharge were smoking (RR, 3.006; 95% CI, 1.123–8.044) and 60 years of age (RR, 4.150; 95% CI, 1.611–10.686). Maleness was protective for medical complications (RR, 0.024; 95% CI, 0.005–0.126). Risk factors for surgical complications were obese class II (RR, 4.120; 95% CI, 1.123–15.120]), chronic obstructive pulmonary disease (COPD; RR, 21.981; 95% CI, 3.719–129.924), and inpatient surgery (RR, 8.606; 95% CI, 2.266–32.689). An independent functional status was protective against surgical complications (RR, 0.023; 95% CI, 0.002–0.221).Conclusions: Overall complication rates after distal biceps repair are quite low. Patient demographics (sex, age, BMI, and functional status), medical comorbidities (diabetes, smoking, and COPD), and surgical factors (inpatient versus outpatient surgery) were all predictive of various short-term complications.

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Outcomes of Elective Total Hip Arthroplasty in Nonagenarians and Centenarians

Cited by 16 publications

References 45 publications

Hip and Knee Arthroplasty Outcomes for Nonagenarian Patients

Hip and Knee Arthroplasty Outcomes for Nonagenarian Patients

Increased 30-Day Postoperative Readmission and Medical Complication Rates Among Patients 65 Years and Older Following Arthroscopic Rotator Cuff Repair

Determining the incidence and risk factors for short-term complications following distal biceps tendon repair

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