Gupta Puneet, Quan Theodore, Zimmer Zachary R
Department of Orthopaedic Surgery, George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
Shoulder Elbow. 2022 Aug;14(4):402-409. doi: 10.1177/17585732211027334. Epub 2021 Jun 26.
Octogenarians are at an increased risk of morbidity and mortality following various surgeries, but this has not yet been well explored in octogenarians undergoing revision total shoulder arthroplasty (RTSA). Thus, the purpose of this study was to analyze whether octogenarians undergoing RTSA are at an increased risk of 30-day postoperative complications, readmissions, and mortality relative to the younger geriatric population.
Data of patients who underwent RTSA from 2013 to 2018 were obtained from a large de-identified database. Patients were divided into two cohorts: ages 65-79 and ages 80-89. Demographic data, comorbidities, and postoperative complications were collected and compared between the two cohorts. Bivariate and multivariate analyses were performed.
On bivariate analyses, patients aged 80-89 were more likely to develop pulmonary embolism (p = 0.014) and extended length of stay more than 3 days (p = 0.006) compared to the cohort aged 65-79. Following adjustment on multivariate analyses, 80-89 years old patients no longer had an increased likelihood of pulmonary embolism or extended length of stay compared to the 65-79 age group. Octogenarians were not found to have higher rates of 30-day readmissions (p = 0.782), mortality (p = 0.507), reoperation (p = 0.785), pneumonia (p = 0.417), urinary tract infection (p = 0.739), or sepsis (p = 0.464) compared to the cohort aged 65-79 following RTSA.
Age greater than 80 should not be used independently as a factor for evaluating whether a geriatric patient is a proper candidate for RTSA.
八旬老人在接受各种手术后发病和死亡风险增加,但在接受翻修全肩关节置换术(RTSA)的八旬老人中,这一点尚未得到充分研究。因此,本研究的目的是分析接受RTSA的八旬老人相对于年轻老年人群体,术后30天并发症、再入院和死亡风险是否增加。
从一个大型匿名数据库中获取2013年至2018年接受RTSA的患者数据。患者分为两个队列:65 - 79岁和80 - 89岁。收集两个队列的人口统计学数据、合并症和术后并发症并进行比较。进行了双变量和多变量分析。
双变量分析显示,与65 - 79岁队列相比,80 - 89岁患者发生肺栓塞的可能性更高(p = 0.014),住院时间延长超过3天的可能性更高(p = 0.006)。多变量分析调整后,与65 - 79岁年龄组相比,80 - 89岁患者发生肺栓塞或住院时间延长的可能性不再增加。与接受RTSA后的65 - 79岁队列相比,未发现八旬老人30天再入院率(p = 0.782)、死亡率(p = 0.507)、再次手术率(p = 0.785)、肺炎发生率(p = 0.417)、尿路感染发生率(p = 0.739)或败血症发生率(p = 0.464)更高。
不应单独将年龄大于80岁作为评估老年患者是否适合进行RTSA的因素。