Department of Orthopaedic Surgery, George Washington School of Medicine and Health Sciences, Washington DC.
Department of Orthopaedic Surgery, Hospital for Special Surgery, New York.
J Knee Surg. 2023 Jun;36(7):779-784. doi: 10.1055/s-0042-1743227. Epub 2022 Mar 8.
Same-day discharge pathways in total knee arthroplasty (TKA) are gaining popularity as a means to increase patient satisfaction and reduce overall costs, but these pathways have not been thoroughly evaluated in potentially at-risk populations, such as in patients ≥80 years old. The purpose of this study was to compare 90-day complications and mortality following same-day discharge after primary TKA in patients ≥80 years old and those <80 years old. Patients who underwent unilateral primary TKA, were discharged on postoperative day 0, and had a minimum 90-day follow-up were identified in a national insurance claims database (PearlDiver Technologies) using Current Procedural Terminology code 27447. These patients were stratified into two cohorts based upon age: (1) nonoctogenarians (<80 years old) and (2) octogenarians (≥80 years old). These cohorts were propensity matched based upon sex, Charlson comorbidity index, and obesity status. Univariate analysis was performed to determine differences in 90-day complications and mortality between the two cohorts. In total, 1,111 patients were included in each cohort. Both cohorts were successfully matched, with no observed differences in matched parameters for demographics or comorbidities. There was no significant difference in 90-day mortality between the two cohorts ( = 0.896). However, octogenarians were at significantly increased risk of postoperative atrial fibrillation (20.8 vs. 10.4%; < 0.001), nonatrial fibrillation arrhythmias (8.4 vs. 5.6%; = 0.009), pneumonia (4.5 vs. 2.2%; = 0.002), stroke (3.1 vs. 1.7%; = 0.037), heart failure (10.5 vs. 7.5%; = 0.012), and urinary tract infection (UTI; 14.3 vs. 9.4%; < 0.001) compared with the nonoctogenarian cohort. Relative to matched controls, octogenarians were at significantly increased risk of numerous 90-day medical complications following same-day primary TKA, including cardiopulmonary complications, stroke, and UTI. Clinicians should be cognizant of these complications and counsel patients appropriately when electing to perform same-day TKA in the octogenarian population.
同一天出院路径在全膝关节置换术（TKA）中越来越受欢迎，因为它可以提高患者满意度并降低整体成本，但这些路径尚未在潜在的高危人群中得到彻底评估，例如 80 岁以上的患者。本研究的目的是比较 80 岁以上和 80 岁以下患者在接受初次 TKA 后同一天出院 90 天内的并发症和死亡率。在国家保险索赔数据库（PearlDiver Technologies）中，使用当前程序术语代码 27447 ，通过单侧初次 TKA 、术后第 0 天出院和至少 90 天随访，确定了患者。这些患者根据年龄分为两组：（1）非 80 岁以下（<80 岁）和（2）80 岁以上（≥80 岁）。这两组基于性别、Charlson 合并症指数和肥胖状况进行倾向评分匹配。采用单变量分析确定两组 90 天并发症和死亡率的差异。共有 1111 名患者被纳入每个队列。两组均成功匹配，匹配参数在人口统计学或合并症方面无差异。两组 90 天死亡率无显著差异（=0.896）。然而，80 岁以上患者术后心房颤动的风险显著增加（20.8%对 10.4%；<0.001），非心房颤动心律失常（8.4%对 5.6%；=0.009），肺炎（4.5%对 2.2%；=0.002），中风（3.1%对 1.7%；=0.037），心力衰竭（10.5%对 7.5%；=0.012）和尿路感染（UTI；14.3%对 9.4%；<0.001）明显高于非 80 岁以下患者。与匹配对照组相比，80 岁以上患者在同一天初次 TKA 后发生多种 90 天医疗并发症的风险显著增加，包括心肺并发症、中风和 UTI。临床医生在选择对 80 岁以上人群进行同一天 TKA 时，应注意这些并发症并适当告知患者。
