Leopold Vincent J, Krull Paula, Hardt Sebastian, Hipfl Christian, Melsheimer Oliver, Steinbrück Arnd, Perka Carsten, Giebel Gregor M
Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany.
German Arthroplasty Registry (EPRD Endoprothesenregister Deutschland), Berlin, Germany.
J Bone Joint Surg Am. 2023 Oct 18;105(20):1583-1593. doi: 10.2106/JBJS.23.00092. Epub 2023 Aug 25.
An increasing number of elderly patients are becoming candidates for elective total hip arthroplasty (THA). Conflicting results exist with regard to the safety of THA in nonagenarians. The aims of this study were to evaluate postoperative mortality and morbidity after THA in nonagenarians and underlying risk factors. We hypothesized that nonagenarians undergoing elective THA would show higher morbidity than younger patients and higher mortality than nonagenarians in the general population.
This was an observational cohort study using data from the German Arthroplasty Registry (Endoprothesenregister Deutschland [EPRD]). Of 323,129 THAs, 263,967 (including 1,859 performed on nonagenarians) were eligible. The mean follow-up (and standard deviation) was 1,070 ± 641 days (range, 0 to 3,060 days). The exclusion criteria were age of <60 years at admission and nonelective THAs or hemiarthroplasties. The cohort was divided into 4 age groups: (1) 60 to 69 years, (2) 70 to 79 years, (3) 80 to 89 years, and (4) ≥90 years. Comorbidities representing independent risk factors for postoperative complications and mortality were identified via a logistic regression model. Mortality rates were compared with those from the general population with data from the Federal Statistical Office. The end points of interest were postoperative major complications, minor complications, and mortality.
Among the greatest risk factors for major and minor complications and mortality were congestive heart failure, pulmonary circulation disorders, insulin-dependent diabetes, renal failure, coagulopathy, and fluid and electrolyte disorders. Compared with younger groups, the risks of major and minor complications and mortality were significantly higher in nonagenarians. Mortality increased when major complications occurred. After 1 year, the survival rate in patients without a major complication was 94.4% compared with 79.8% in patients with a major complication. The mortality rates of nonagenarians in the study population were lower than those in the corresponding age group of the general population. The 1-year mortality rates at 90 years of age were 10.5% for men and 6.4% for women within the study group compared with 18.5% for men and 14.7% for women among the general population.
Comorbidities favor the occurrence of complications after elective THA in nonagenarians and thus increase postoperative morbidity. In the case of complications, mortality is also increased. The fact that mortality is still lower than within the general population shows that this aspect can be controlled by careful patient selection and adequate preparation.
Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.
越来越多的老年患者成为择期全髋关节置换术（THA）的候选对象。关于非agenarians行THA的安全性，存在相互矛盾的结果。本研究的目的是评估非agenarians行THA术后的死亡率和发病率以及潜在风险因素。我们假设，接受择期THA的非agenarians比年轻患者的发病率更高，比一般人群中的非agenarians死亡率更高。
这是一项观察性队列研究，使用来自德国关节置换登记处（Endoprothesenregister Deutschland [EPRD]）的数据。在323,129例THA中，263,967例（包括1,859例在非agenarians中进行的手术）符合条件。平均随访时间（及标准差）为1,070±641天（范围为0至3,060天）。排除标准为入院时年龄<60岁以及非择期THA或半髋关节置换术。该队列分为4个年龄组：（1）60至69岁，（2）70至79岁，（3）80至89岁，（4）≥90岁。通过逻辑回归模型确定代表术后并发症和死亡率独立风险因素的合并症。将死亡率与联邦统计局提供的一般人群数据进行比较。感兴趣的终点是术后主要并发症、次要并发症和死亡率。
充血性心力衰竭、肺循环障碍、胰岛素依赖型糖尿病、肾衰竭、凝血障碍以及液体和电解质紊乱是主要和次要并发症及死亡率的最大风险因素。与年轻组相比，非agenarians发生主要和次要并发症及死亡的风险显著更高。发生主要并发症时死亡率增加。1年后，无主要并发症患者的生存率为94.4%，而有主要并发症患者的生存率为79.8%。研究人群中非agenarians的死亡率低于一般人群相应年龄组的死亡率。在研究组中，90岁男性的1年死亡率为10.5%，女性为6.4%，而在一般人群中，男性为18.5%，女性为14.7%。
合并症有利于非agenarians择期THA术后并发症的发生，从而增加术后发病率。发生并发症时，死亡率也会增加。死亡率仍低于一般人群这一事实表明，这方面可通过仔细的患者选择和充分的准备来控制。
治疗水平III。有关证据水平的完整描述，请参阅作者须知。
