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

Autor:	Lucero, Carlos M., García-Mansilla, Agustín, Albani-Forneris, Agustín, Holc, Fernando, Slullitel, Pablo A., Zanotti, Gerardo, Comba, Fernando, Piccaluga, Francisco, Buttaro, Martin A.
Předmět:	OCTOGENARIANS STATISTICS TOTAL hip replacement FRAIL elderly CONFIDENCE intervals AGE distribution MULTIVARIATE analysis SURGICAL complications PATIENT readmissions NONAGENARIANS RETROSPECTIVE studies REGRESSION analysis MANN Whitney U Test FISHER exact test RISK assessment SEX distribution T-test (Statistics) CHI-squared test DESCRIPTIVE statistics BODY mass index ODDS ratio DATA analysis software DISEASE risk factors OLD age
Zdroj:	European Journal of Orthopaedic Surgery & Traumatology; Oct2023, Vol. 33 Issue 7, p2981-2986, 6p
Abstrakt:	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. [ABSTRACT FROM AUTHOR]
Databáze:	Complementary Index
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