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European Journal of Orthopaedic Surgery & Traumatology

Erschienen in:

17.03.2023 | Original Article

Do nonagenarians have more complications and unplanned readmissions than octogenarians following primary THA? A retrospective cohort study

verfasst von: Carlos M. Lucero, Agustín García-Mansilla, Agustín Albani-Forneris, Fernando Holc, Pablo A. Slullitel, Gerardo Zanotti, Fernando Comba, Francisco Piccaluga, Martin A. Buttaro

Erschienen in: European Journal of Orthopaedic Surgery & Traumatology | Ausgabe 7/2023

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Abstract

Introduction

The performance of total hip arthroplasty in elderly patients, especially nonagenarians, is challenging due to higher patient frailty and medical comorbidities. We compared 90-day postoperative complications and unplanned readmissions between nonagenarians and octogenarians undergoing elective THA.

Methods

One hundred and eleven patients undergoing elective, unilateral THA were retrospectively analyzed. Forty-four patients were nonagenarians (Group A), and 67 patients were octogenarians (Group B). Demographic data included age, gender, body mass index (BMI), ASA score and Charlson Comorbidity Index (CCI). Frailty was defined according to the Rockwood Frailty Index. All patients underwent a thorough preoperative assessment through a specific institutional clinical pathway created for this matter. Postoperative adverse events were grouped into major or minor. A regression model was used to evaluate independent risk factors for the development of complications.

Results

There were no differences in the ASA score (65.9% vs. 53.7% ASA III-IV), prevalence of frailty (1% vs. 9%) and comorbidities between both groups (p > .05). The CCI was higher in nonagenarians (p = 0.007). Nonagenarians had more in-hospital complications, although most were minor (p = 0.002), none of which resulted in mortality. Ninety-day unplanned readmissions were similar between groups, with 4 (9.1%) and 6 (9%) in groups A and B, respectively (p = 1). Although age was a factor associated with the development of postoperative complications in the univariate regression model (OR 3.81, 95% CI 1.31 to 11.11, p = 0.014), it lost significance after performing the multivariate analysis (OR 2.48, 95% CI 0.78 to 7.90, p = 0.125).

Conclusion

The age of 90 years old was not a barrier to perform elective THA safely. Nonagenarians had higher in-hospital minor complications when compared to the younger cohort. However, age over 90 years was not an independent risk factor for unplanned readmissions or mortality. Multimodal protocols of perioperative care are paramount for improving outcomes after THA in very old patients.

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Titel: Do nonagenarians have more complications and unplanned readmissions than octogenarians following primary THA? A retrospective cohort study
verfasst von: Carlos M. Lucero
Agustín García-Mansilla
Agustín Albani-Forneris
Fernando Holc
Pablo A. Slullitel
Gerardo Zanotti
Fernando Comba
Francisco Piccaluga
Martin A. Buttaro
Publikationsdatum: 17.03.2023
Verlag: Springer Paris
Erschienen in: European Journal of Orthopaedic Surgery & Traumatology / Ausgabe 7/2023
Print ISSN: 1633-8065
Elektronische ISSN: 1432-1068
DOI: https://doi.org/10.1007/s00590-023-03502-4

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Do nonagenarians have more complications and unplanned readmissions than octogenarians following primary THA? A retrospective cohort study