Zak Stephen Gerard, Lygrisse Katherine, Tang Alex, Meftah Morteza, Long William J, Schwarzkopf Ran
Orthopedic Surgery, NYU Langone Orthopedic Center, New York, New York, USA.
Bone Jt Open. 2021 Jul;2(7):535-539. doi: 10.1302/2633-1462.27.BJO-2021-0048.R1.
As our population ages, the number of octogenarians who will require a total hip arthroplasty (THA) rises. In a value-based system where operative outcomes are linked to hospital payments, it is necessary to assess the outcomes in this population. The purpose of this study was to compare outcomes of elective, primary THA in patients ≥ 80 years old to those aged < 80.
A retrospective review of 10,251 consecutive THA cases from 2011 to 2019 was conducted. Patient-reported outcome (PRO) scores (Hip disability and Osteoarthritis Outcome Score (HOOS)), as well as demographic, readmission, and complication data, were collected.
On average, the younger cohort (YC, n = 10,251) was a mean 61.60 years old (SD 10.71), while the older cohort (OC, n = 609) was 84.25 years old (SD 3.02) (p < 0.001). The OC had greater surgical risk based on their higher mean American Society of Anesthesiologists (ASA) scores (2.74 (SD 0.63) vs 2.30 (SD 0.63); p < 0.001) and Charlson Comorbidity Index (CCI) scores (6.26 (SD 1.71) vs 3.87 (SD 1.98); p < 0.001). While the OC stayed in the hospital longer than the YC (mean 3.5 vs 2.5 days; p < 0.001), there were no differences in 90-day emergency visits (p = 0.083), myocardial infarctions (p = 0.993), periprosthetic joint infections (p = 0.214), dislocations (p = 0.993), or aseptic failure (p = 0.993). The YC was more likely to be readmitted within 90 days (3.88% vs 2.18%, = 0.57; p = 0.048). There were no observed differences in 12-week (p = 0.518) or one-year (p = 0.511) HOOS scores.
Although patients ≥ 80 years old have a greater number of comorbidities than younger patients, they had equivalent perioperative complication rates and PRO scores. This study demonstrates the safety and success of elective THA in octogenarians. Cite this article: 2021;2(7):535-539.
随着我国人口老龄化，需要进行全髋关节置换术（THA）的八旬老人数量不断增加。在一个手术结果与医院支付挂钩的价值导向型体系中，有必要评估这一人群的手术结果。本研究的目的是比较80岁及以上患者与80岁以下患者择期初次全髋关节置换术的结果。
对2011年至2019年连续10251例全髋关节置换术病例进行回顾性研究。收集患者报告的结局（PRO）评分（髋关节功能障碍和骨关节炎结局评分（HOOS））以及人口统计学、再入院和并发症数据。
平均而言，较年轻队列（YC，n = 10251）的平均年龄为61.60岁（标准差10.71），而较年长队列（OC，n = 609）的平均年龄为84.25岁（标准差3.02）（p < 0.001）。基于较高的平均美国麻醉医师协会（ASA）评分（2.74（标准差0.63）对2.30（标准差0.63）；p < 0.001）和Charlson合并症指数（CCI）评分（6.26（标准差1.71）对3.87（标准差1.98）；p < 0.001），OC的手术风险更高。虽然OC的住院时间比YC长（平均3.5天对2.5天；p < 0.001），但在90天急诊就诊（p = 0.083）、心肌梗死（p = 0.993）、假体周围关节感染（p = 0.214）、脱位（p = 0.993）或无菌性失败（p = 0.993）方面没有差异。YC在90天内再次入院的可能性更高（3.88%对2.18%， = 0.57；p = 0.048）。在12周（p = 0.518）或1年（p = 0.511）的HOOS评分中未观察到差异。
尽管80岁及以上患者的合并症比年轻患者多，但他们的围手术期并发症发生率和PRO评分相当。本研究证明了八旬老人择期全髋关节置换术的安全性和成功率。引用本文：2021；2(7):535 - 539。
