School of Medicine, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia.
The University of Melbourne and St. Vincent's Hospital Melbourne, Melbourne, Australia.
Bone Joint J. 2018 Nov;100-B(11):1463-1470. doi: 10.1302/0301-620X.100B11.BJJ-2017-0753.R6.
As the population ages, there is projected to be an increase in the level of demand for total knee arthroplasty (TKA) in octogenarians. We aimed to explore whether those aged ≥ 80 years achieved similar improvements in physical function to younger patients while also comparing the rates of length of stay (LOS), discharge to rehabilitation, postoperative complications, and mortality following TKA in older and younger patients.
Patients from one institution who underwent primary elective TKA between 1 January 2006 and 31 December 2014 were dichotomized into those ≥ 80 years old (n = 359) and those < 80 years old (n = 2479) for comparison. Multivariable regression was used to compare the physical status component of the 12-Item Short-Form Health Survey (SF-12), LOS, discharge to rehabilitation, complications, and mortality between the two groups.
Both age groups demonstrated a clinically meaningful improvement in their self-reported physical health relative to their baseline with no clinically relevant difference noted between them. Being ≥ 80 years old was associated with a 0.58-day increase in LOS and older patients were more likely to be discharged to rehabilitation (odds ratio (OR) 3.06, p < 0.001). Medical complications and mortality were higher in elderly patients (OR 1.92 for complications, p < 0.001; hazard ratio 3.40 for death, p < 0.001). There was no statistically significant association between age group and experiencing a postoperative surgical or wound-related complication.
Those aged over 80 years achieved a statistically significant lower median SF-12 physical score than the younger group, after adjusting for the preoperative score, but this difference of 4.46 was not considered to be clinically meaningful. However, clinicians should be aware that the elderly are at a higher risk of experiencing longer hospital stays, postoperative medical complications, and mortality. Cite this article: Bone Joint J 2018;100-B:1463-70.
随着人口老龄化，预计 80 岁以上人群对全膝关节置换术（TKA）的需求水平将会增加。我们旨在探讨 80 岁及以上患者在接受 TKA 后，其身体功能是否能像年轻患者一样得到显著改善，并比较两组患者的住院时间（LOS）、康复出院率、术后并发症和死亡率。
我们将一家机构在 2006 年 1 月 1 日至 2014 年 12 月 31 日期间接受初次择期 TKA 的患者分为 80 岁及以上（n=359）和 80 岁以下（n=2479）两组进行比较。采用多变量回归比较两组患者 12 项简明健康调查问卷（SF-12）身体状况评分、LOS、康复出院率、并发症和死亡率。
两组患者的自我报告身体健康状况均较基线有显著改善，且差异无临床意义。80 岁及以上患者的 LOS 增加 0.58 天，更有可能被送往康复机构（比值比（OR）3.06，p<0.001）。老年患者的医疗并发症和死亡率更高（OR 1.92，并发症，p<0.001；死亡，HR 3.40，p<0.001）。年龄组与术后手术或伤口相关并发症之间无统计学显著相关性。
在调整术前评分后，80 岁以上患者的 SF-12 身体评分中位数明显低于年轻患者，但两者相差 4.46 分，这一差异无临床意义。然而，临床医生应意识到，老年人发生住院时间延长、术后医疗并发症和死亡率增加的风险更高。
