As an increasing number of patients aged 80 years and older undergo elective orthopaedic surgery, a new study indicates that these surgeries are generally safe, with mortality rates on the decline for total hip (THR) and total knee (TKR) replacement and spinal fusion surgeries. The study results also suggest that complication rates are decreasing for TKR and spinal fusion in patients who have few or no comorbidities.
During the study, an American Academy of Orthopaedic Surgeons (AAOS) news release states that researchers investigated data regarding patients aged 80 years and older, and patients aged 65 to 79 years old, from the Nationwide Inpatient Sample (NIS). Patient sex, race, comorbidities, complications, mortality, duration of hospital stay, whether or not patients were discharged to their home or to a rehabilitation facility, and total hospital charges were gathered and analyzed.
The release notes that among the patients in the NIS database who were at least 80 years of age, 417,460 underwent TKR, 233,277 THR, and 70,203 spinal fusion between the years 2000 and 2009. Among patients in the 65 to 79 year old range, 1,868,983 underwent TKR, 768,999 THR, and 522,369 spinal fusion.
Additional study findings include that overall in-hospital complication rate remained stable, dipping slightly from 2000 to 2009 in the 80 years and older patient group for spinal fusion (from 17.5% to 16.1%) and for TKR (from 9.9% to 9.1%). The results also suggest that complication rate increased for THR from 9% to 10.3%
In-hospital mortality rate in the 80 years and older age group averaged .5% for THR, .3% for TKR, and .9% for spinal fusion. The researchers add that while overall in-hospital complication and mortality rates were significantly higher in patients aged 80 years and older compared to patients aged 65 to 79 years for all three procedures, the difference was small.
Hiroyuki Yoshihara, MD, PhD, lead study author, orthopaedic surgeon at State University of New York (SUNY) Downstate Medical Center and Nassau University Medical Center, states that in light of the study’s results, older adult patients, particularly those who have few comorbidities, may want to consider the benefits of the procedures.