Abstract
We compared inpatient postoperative complication rates between octogenarians and nonagenarians undergoing primary and revision total hip arthroplasty (THA). We used inpatient admission data from 2010–2014 from the Nationwide Inpatient Sample (NIS). We compared the rates at which nonagenarians and octogenarians developed each complication in the inpatient setting following both primary THA (PTHA) and revision THA (RTHA). A total of 40,944 inpatient admissions were included in our study which extrapolates to a national estimate of 199,793 patients. A total of 185,799 (93%) were octogenarians and 13,994 (7%) were nonagenarians. PTHA was performed on 155,669 (78%) and RTHA was performed on 44,124 (22%) of the patients. Nonagenarians undergoing PTHA required transfusions significantly more frequently (33.13% v. 24.0%, p < 0.001) and developed urinary tract infection (5.14% v. 3.92%, p = 0.012) and acute kidney injury (5.50% v. 3.57%, p < 0.001) significantly more frequently than octogenarians. Nonagenarians undergoing RTHA required transfusions significantly more frequently (51.43% v. 41.46%, p < 0.001) and developed urinary tract infection (19.66% v. 11.73%, p < 0.001), acute kidney injury (13.8% v. 9.66%, p < 0.001), pulmonary embolism (1.24% v. 0.67%, p = 0.031), postoperative infection (1.89% v. 1.11%, p = 0.023), sepsis (3.59% v. 2.43%, p = 0.021) and other postoperative shock (1.76% v. 1.06%, p = 0.036) significantly more frequently than octogenarians. Nonagenarians undergoing RTHA also had a significantly higher inpatient mortality rate (3.28% v. 1.43%, p < 0.001) than octogenarians. Orthopedic surgeons and primary care providers can use these findings to help counsel both their octogenarian and nonagenarian patients preoperatively when considering THA. Our analysis can help these patients better understand expected inpatient complication rates and assist them in deciding whether to pursue surgical intervention when applicable.
Highlights
The age demographics of the United States are changing, with the elderly continuing to constitute an expanding proportion of the population
It is important that orthopedic surgeons as well as primary care providers and other members of the care team have an understanding of the expected postoperative inpatient course of nonagenarians undergoing total joint arthroplasty
We found no significant difference in inpatient mortality rate between octogenarians and nonagenarians undergoing primary THA (PTHA) (0.18% vs. 0.19%), nonagenarians undergoing revision THA (RTHA) had a significantly higher inpatient mortality rate than octogenarians (3.28% vs. 1.43%), even after controlling for likely confounding variables including number of diagnoses, number of chronic diagnoses and Charlson Comorbidity Index
Summary
The age demographics of the United States are changing, with the elderly continuing to constitute an expanding proportion of the population. By 2060, almost 25% of the United States population is projected to be composed of patients over age 65 and between 2010 and 2050 the number of Americans. The volume of total joint arthroplasties performed on nonagenarians will likely increase rapidly as this age cohort grows in number. Some orthopedic surgeons may be reluctant to perform total joint arthroplasty on a nonagenarian due to the significant number of medical comorbidities expected in this age demographic [3]. It is important that orthopedic surgeons as well as primary care providers and other members of the care team have an understanding of the expected postoperative inpatient course of nonagenarians undergoing total joint arthroplasty. Orthopedic surgeons, in particular, could use this knowledge to more efficiently direct focused efforts at reducing common postoperative inpatient complications and better guide their conversations with patients preoperatively when discussing whether or not to pursue surgery
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