'Sir John Charnley' Hip Surgery Unit, Institute of Orthopaedics 'Carlos E. Ottolenghi', Italian Hospital of Buenos Aires, 4190 Peron St., C1199ABH, Buenos Aires, Argentina.
Eur J Orthop Surg Traumatol. 2023 Oct;33(7):2981-2986. doi: 10.1007/s00590-023-03502-4. Epub 2023 Mar 17.
The performance of total hip arthroplasty in elderly patients, especially nonagenarians, is challenging due to higher patient frailty and medical comorbidities. We compared 90-day postoperative complications and unplanned readmissions between nonagenarians and octogenarians undergoing elective THA.
One hundred and eleven patients undergoing elective, unilateral THA were retrospectively analyzed. Forty-four patients were nonagenarians (Group A), and 67 patients were octogenarians (Group B). Demographic data included age, gender, body mass index (BMI), ASA score and Charlson Comorbidity Index (CCI). Frailty was defined according to the Rockwood Frailty Index. All patients underwent a thorough preoperative assessment through a specific institutional clinical pathway created for this matter. Postoperative adverse events were grouped into major or minor. A regression model was used to evaluate independent risk factors for the development of complications.
There were no differences in the ASA score (65.9% vs. 53.7% ASA III-IV), prevalence of frailty (1% vs. 9%) and comorbidities between both groups (p > .05). The CCI was higher in nonagenarians (p = 0.007). Nonagenarians had more in-hospital complications, although most were minor (p = 0.002), none of which resulted in mortality. Ninety-day unplanned readmissions were similar between groups, with 4 (9.1%) and 6 (9%) in groups A and B, respectively (p = 1). Although age was a factor associated with the development of postoperative complications in the univariate regression model (OR 3.81, 95% CI 1.31 to 11.11, p = 0.014), it lost significance after performing the multivariate analysis (OR 2.48, 95% CI 0.78 to 7.90, p = 0.125).
The age of 90 years old was not a barrier to perform elective THA safely. Nonagenarians had higher in-hospital minor complications when compared to the younger cohort. However, age over 90 years was not an independent risk factor for unplanned readmissions or mortality. Multimodal protocols of perioperative care are paramount for improving outcomes after THA in very old patients.
由于患者身体虚弱和合并症较多，对于 90 岁以上的老年患者，尤其是 90 岁以上的患者，全髋关节置换术的疗效具有挑战性。我们比较了接受择期全髋关节置换术的 90 天术后并发症和非计划性再入院率在 90 岁以上和 80 岁以上患者之间的差异。
回顾性分析了 111 例接受择期单侧全髋关节置换术的患者。44 例患者为 90 岁以上（A 组），67 例患者为 80 岁以上（B 组）。人口统计学数据包括年龄、性别、体重指数（BMI）、ASA 评分和 Charlson 合并症指数（CCI）。身体虚弱根据 Rockwood 虚弱指数来定义。所有患者均通过专门为此事创建的特定机构临床路径进行了全面的术前评估。术后不良事件分为主要和次要事件。使用回归模型评估并发症发生的独立危险因素。
两组间 ASA 评分（65.9%比 53.7%ASA III-IV）、虚弱发生率（1%比 9%）和合并症的患病率（p>0.05）无差异。90 岁以上患者的 CCI 较高（p=0.007）。90 岁以上患者的院内并发症更多，但大多数为轻微并发症（p=0.002），且均无死亡病例。两组间 90 天非计划性再入院率相似，A 组和 B 组分别有 4 例（9.1%）和 6 例（9%）（p=1）。虽然年龄是单因素回归模型中与术后并发症发生相关的因素（OR 3.81，95%CI 1.31-11.11，p=0.014），但在进行多因素分析后，其意义丧失（OR 2.48，95%CI 0.78-7.90，p=0.125）。
90 岁并非安全行择期全髋关节置换术的障碍。与年轻患者相比，90 岁以上患者的院内轻微并发症更高。然而，90 岁以上的年龄并不是非计划性再入院或死亡的独立危险因素。围手术期多模式护理方案对于改善高龄患者全髋关节置换术后的结果至关重要。
