高龄患者髋关节和膝关节置换术的结果。
Hip and Knee Arthroplasty Outcomes for Nonagenarian Patients.
机构信息
From the Department of Orthopaedic Surgery, Scripps Clinic, La Jolla, CA (Sizer, Bugbee, Copp, Ezzet, Walker, and Rosen), and Shiley Center for Orthopaedic Research and Education at Scripps Clinic, La Jolla, CA (McCauley, Luu, and Densley).
出版信息
J Am Acad Orthop Surg. 2022 Nov 15;30(22):1090-1097. doi: 10.5435/JAAOS-D-22-00406. Epub 2022 Sep 1.
INTRODUCTION
Studies have previously reported higher complication rates in elective total joint arthroplasty (TJA) for nonagenarians compared with younger cohorts. The purpose of this study was to assess whether nonagenarians were still at increased risk of complications and hospital readmissions by answering three questions: (1) Do nonagenarians have an increased risk of medical complications after TJA compared with octogenarians and septuagenarians? (2) Do nonagenarians have an increased risk of surgical complications after TJA compared with octogenarians and septuagenarians? (3) Do nonagenarians have an increased risk of hospital readmission after TJA compared with octogenarians and septuagenarians?
METHODS
A total of 174 patients undergoing primary TJA between 2010 and 2017 were included; 58 nonagenarians (older than 90 years) were matched with 58 octogenarians (age 80 to 84 years) and 58 septuagenarians (age 70 to 74). Groups were matched by sex, diagnosis, surgeon, surgical joint, and year of surgery. Within each group, 31 patients (53%) underwent total hip arthroplasty and 27 patients (47%) underwent total knee arthroplasty. Comorbidities, American Society of Anesthesiologists physical status scores, and Charlson Comorbidity Index scores were captured preoperatively. Complications and readmissions occurring within 90 days postoperatively were evaluated.
RESULTS
Nonagenarians had the highest rate of medical complications (33%) compared with octogenarians (14%) and septuagenarians (3%) (P < 0.001). Rates of surgical complications were not statistically different among nonagenarians (12%), octogenarians (9%), and septuagenarians (10%) (P = 0.830). Rates of hospital readmission were highest in nonagenarian patients (11%), but not statistically different compared with octogenarians (5%) or septuagenarians (2%) (P = 0.118).
CONCLUSION
Nonagenarians were 3.1 times more likely to have a complication after TJA. The incidence of medical complications was highest in nonagenarians compared with octogenarians and septuagenarians, but rates of orthopaedic complications were similar. Nonagenarians who elect to proceed with TJA should be informed that they have an increased risk of postoperative medical complications compared with younger patients undergoing the same operation.
LEVEL OF EVIDENCE
Level III, Therapeutic Study.
简介
先前的研究报告称，与年轻队列相比，非 90 岁人群在择期全关节置换术（TJA）中并发症发生率更高。本研究旨在通过回答三个问题来评估 90 岁以上人群在 TJA 后是否仍有更高的并发症和再入院风险：（1）与 80 岁和 70 岁人群相比，90 岁以上人群在 TJA 后是否有更高的医疗并发症风险？（2）与 80 岁和 70 岁人群相比，90 岁以上人群在 TJA 后是否有更高的手术并发症风险？（3）与 80 岁和 70 岁人群相比，90 岁以上人群在 TJA 后是否有更高的再入院风险？
方法
共纳入 2010 年至 2017 年间接受初次 TJA 的 174 例患者；58 例 90 岁以上患者（大于 90 岁）与 58 例 80-84 岁患者（80 岁至 84 岁）和 58 例 70-74 岁患者（70 岁至 74 岁）相匹配。各组通过性别、诊断、外科医生、手术关节和手术年份进行匹配。在每个组中，31 例患者（53%）接受全髋关节置换术，27 例患者（47%）接受全膝关节置换术。术前评估了合并症、美国麻醉医师协会身体状况评分和 Charlson 合并症指数评分。评估了术后 90 天内发生的并发症和再入院情况。
结果
与 80 岁和 70 岁人群相比，90 岁以上人群的医疗并发症发生率最高（33%），而 80 岁和 70 岁人群分别为 14%和 3%（P < 0.001）。90 岁以上人群（12%）、80 岁人群（9%）和 70 岁人群（10%）的手术并发症发生率无统计学差异（P = 0.830）。90 岁以上患者的再入院率最高（11%），但与 80 岁患者（5%）或 70 岁患者（2%）相比，差异无统计学意义（P = 0.118）。
结论
与 TJA 后，90 岁以上人群发生并发症的可能性增加 3.1 倍。与 80 岁和 70 岁人群相比，90 岁以上人群的医疗并发症发生率最高，但骨科并发症发生率相似。选择接受 TJA 的 90 岁以上人群应被告知，与接受相同手术的年轻患者相比，他们术后发生医疗并发症的风险更高。
证据水平
III 级，治疗性研究。
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