D'Apuzzo Michele R, Pao Andrew W, Novicoff Wendy M, Browne James A
Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia.
J Arthroplasty. 2014 Mar;29(3):477-80. doi: 10.1016/j.arth.2013.07.045. Epub 2013 Sep 9.
The population of patients over 90 years of age has experienced the fastest growth in recent years. The number of primary total joint arthroplasties (TJA) has also been increasing. Our objectives were to examine in-hospital morbidity, mortality and resource consumption following primary TJA in patients older than 89 years at the national level. Nationwide Inpatient Sample was used to identify 8,340,167 patients who underwent TJA between 1993 and 2008, 58,355 (0.7%) were 90 years of age or older. Older patients were at higher risk of developing cardiac (OR 2.5; 95% CI 2.4-2.6), neurological (OR 2.1; 95% CI 1.8-2.4), respiratory complications and higher risk of mortality (OR 11.5; 95% CI 10.93-12.1) after controlling for baseline comorbidities. Age is an independent risk factor for postoperative complications and mortality. Our data can be used to educate patients on the risks before undergoing primary TJA and aid physicians in assessing and adjusting perioperative risk.
90岁以上患者群体近年来经历了最快的增长。初次全关节置换术（TJA）的数量也一直在增加。我们的目标是在国家层面研究89岁以上患者初次TJA后的住院发病率、死亡率和资源消耗情况。利用全国住院患者样本确定了1993年至2008年间接受TJA的8340167例患者，其中58355例（0.7%）年龄在90岁及以上。在控制基线合并症后，老年患者发生心脏并发症（比值比2.5；95%置信区间2.4 - 2.6）、神经并发症（比值比2.1；95%置信区间1.8 - 2.4）、呼吸并发症的风险更高，死亡风险也更高（比值比11.5；95%置信区间10.93 - 12.1）。年龄是术后并发症和死亡的独立危险因素。我们的数据可用于在患者接受初次TJA前对其进行风险教育，并帮助医生评估和调整围手术期风险。
