Elective Total Hip Arthroplasties in Nonagenarians-Age Does Matter: A National Surgical Quality Improvement Program
John Antoniou1, Catherine Silotch2, Laura L Epure1
1Department of Orthopedic Surgery, SMBD-Jewish General Hospital, Montreal, Quebec, Canada; Faculty of Medicine and Health Sciences, Department of Surgery and Experimental Surgery, McGill University, Montreal, Quebec, Canada.
Background:
The aim of this study is to assess the independent effect of age on the risk of postsurgical complications and death in patients undergoing total hip arthroplasty (THA).
Methods:
The National Surgical Quality Improvement Program was used to identify all patients aged 65 years and older who underwent primary THA from 2011 to 2017. Study outcomes were minor complications, major life-threatening complications, and 30-day mortality. Predictors of outcomes were identified using bivariate analyses and age was added into the final logistic regression models with stepwise selection.
Results:
A total of 74,361 patients were included in the analysis. Mean (standard deviation) age was 735 years (6.46), median 72.0 years; 1,119 (1.50%) patients were ≥90 years. Females comprised 60.6% of the patient sample. The incidence of major life-threatening complications, minor complications, and death was 939/74,361 (1.3%), 2,098 (2.8%) and 154 (0.2%) respectively. When added to the final models, age was significantly associated with an increased risk of postoperative complications and mortality.
Conclusion:
Elective THA in relatively healthy nonagenarians should only be considered among patients with disabling osteoarthritis demonstrating a restricted quality of life. Although THA can substantially improve patient wellbeing, our findings suggest that surgeons and patients must consider the impact of age on patient course and outcomes regardless of the presence of comorbidities.
Level Of Evidence:
Level II, prognostic study.
