Aseptic revision total hip arthroplasty in the elderly

Bovonratwet, Patawut; Malpani, Rohil; Ottesen, Taylor D.; Tyagi, V.V.; Ondeck, Nathaniel T.; Rubin, Lee E.; Grauer, Jonathan N.

doi:10.1302/0301-620x.100b2.bjj-2017-0895.r1

Cited by 60 publications

(21 citation statements)

References 42 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Previous authors have demonstrated that advanced patient age is associated with higher risks of perioperative complications and an extended length of stay, particularly in octogenarians. 24,25 Interestingly, in the present study our model predicts a shorter length of stay as age increases. This is counterintuitive, as one would expect older patients to have an increased incidence of comorbidities and complications, thereby necessitating a longer LOS in the hospital.…”

Section: Discussionsupporting

confidence: 45%

Perioperative factors associated with increased length of stay after revision of metal-on-metal total hip arthroplasty

Garfinkel

Gladnick²,

Pachter

et al. 2019

Journal of Orthopaedics

View full text Add to dashboard Cite

To investigate patient factors influencing length-of-stay (LOS) after revision metal-on-metal (MoM) total hip arthroplasty (THA). Methods: We reviewed 23 hips undergoing revision of a MoM THA with minimum 2-year follow-up. A multiple linear regression was calculated to predict LOS using multiple variables. Results: Average length of stay (LOS) was 2.1 days. Multiple linear regression analysis identified a significant correlation between presence of an abductor injury (beta = 0.8886; p < 0.0001), patient age (beta = −0.4452, p = 0.0083), and pre-revision head size (beta = 0.4082; p = 0.0172) with LOS (R 2 = 0.6351, p = 0.0002). Conclusion:Patients with abductor injury, larger femoral heads, and younger age are at risk for longer LOS.

show abstract

Section: Discussionsupporting

confidence: 45%

Perioperative factors associated with increased length of stay after revision of metal-on-metal total hip arthroplasty

Garfinkel

Gladnick²,

Pachter

et al. 2019

Journal of Orthopaedics

View full text Add to dashboard Cite

show abstract

“…That said, this is a commonly used database in the field, as can be seen by the many recent studies cited. 12345,18192021222324 Second, it is possible that the observations made here may not apply to other NSQIP study populations. That said, the overall conclusions made here mirror those of the previously referenced lumbar study.…”

Section: Discussionmentioning

confidence: 91%

“…In fact, in the last year alone, nine studies have been published on total hip arthroplasty (THA) using NSQIP data. 123456789…”

mentioning

confidence: 99%

The Use of Older Versus Newer Data in the National Surgical Quality Improvement Program Database Influences the Results of Total Hip Arthroplasty Outcomes Studies

et al. 2019

View full text Add to dashboard Cite

Introduction:National databases, such as the National Surgical Quality Improvement Program (NSQIP) database, are frequently used for total hip arthroplasty (THA) studies. NSQIP variables and the population included in the database have evolved over time. These changes may influence the results of studies using different periods of data.Methods:THA patients were aggregated from the 2005 to 2010 and 2011 to 2015 NSQIP data sets to define two era groups. Demographic data and 30-day perioperative outcomes were compared between the groups. As an example analysis, multivariate Poisson regression was used to determine the correlation between age and perioperative outcomes for each group.Results:Of 102,411 THA patients identified, 8098 cases were from 2005 to 2010 and 94,313 were from 2011 to 2015. A number of preoperative characteristics and perioperative outcomes were significantly different between the era groups. Multivariate analysis of the 2005 to 2010 group showed that increasing age was significantly associated with urinary tract infection and length of stay (LOS), and multivariate analysis of the 2011 to 2015 group showed that age was significantly associated with urinary tract infection, LOS, 30-day mortality, unplanned reintubation, extended LOS, pneumonia, deep vein thrombosis/thrombophlebitis, blood transfusion, and return to the operating room.Conclusion:Significantly more THA patients were enrolled in the NSQIP in the years between 2005 and 2015. Populations in 2005 to 2010 versus 2011 to 2015 were associated with differences in preoperative characteristics and perioperative outcomes. In an example analysis, it was shown that these differences together lead to different study results and conclusions. This needs to be considered when interpreting and conducting studies using earlier NSQIP data.

show abstract

“…ASA ratings correlate with patient medical comorbidities and can be helpful in predicting perioperative risks and outcomes. Previous studies have looked at outcomes for nonagenarians and octogenarians in revision procedures [12][13][14][15][16][17]. Bovonratwet et al found revision TKA to be safe in patients aged over 80 years and concluded that octogenarian patients need not be discouraged from revision TKA solely based on their advanced age [14].…”

Section: Discussionmentioning

confidence: 99%

“…Parvizi et al showed that an rTHA can provide substantial clinical benefit to patients over eighty years of age [16]. However, there is additional evidence that an aseptic rTHA may be associated with greater risks in patients 80 years or older compared to younger patients [17].…”

Section: Discussionmentioning

confidence: 99%

Episode-of-Care Costs for Revision Total Joint Arthroplasties by Decadal Age Groups

et al. 2021

View full text Add to dashboard Cite

The demand for revision total joint arthroplasties (rTJAs) is expected to increase as the age of the population continues to rise. Accurate cost data regarding hospital expenses for differing age groups are needed to deliver optimal care within value-based healthcare (VBHC) models. The aim of this study was to compare the total in-hospital costs by decadal groups following rTJA and to determine the primary drivers of the costs for these procedures. Time-driven activity-based costing (TDABC) was used to capture granular hospital costs. A total of 551 rTJAs were included in the study, with 294 sexagenarians, 198 septuagenarians, and 59 octogenarians and older. Sexagenarians had a lower ASA classification (2.3 vs. 2.4 and 2.7; p < 0.0001) and were more often privately insured (66.7% vs. 24.2% and 33.9%; p < 0.0001) as compared to septuagenarians and octogenarians and older, respectively. Sexagenarians were discharged to home at a higher rate (85.3% vs. 68.3% and 34.3%; p < 0.0001), experienced a longer operating room (OR) time (199.8 min vs. 189.7 min and 172.3 min; p = 0.0195), and had a differing overall hospital length of stay (2.8 days vs. 2.7 days and 3.6 days; p = 0.0086) compared to septuagenarians and octogenarians and older, respectively. Sexagenarians had 7% and 23% less expensive personnel costs from post-anesthesia care unit (PACU) to discharge (p < 0.0001), and 1% and 24% more expensive implant costs (p = 0.077) compared to septuagenarians and octogenarians and older, respectively. Sexagenarians had a lower total in-hospital cost for rTJAs by 0.9% compared to septuagenarians but 12% more expensive total in-hospital costs compared to octogenarians and older (p = 0.185). Multivariate linear regression showed that the implant cost (0.88389; p < 0.0001), OR time (0.12140; p < 0.0001), personnel cost from PACU through to discharge (0.11472; p = 0.0007), and rTHAs (−0.03058; p < 0.0001) to be the strongest associations with overall costs. Focusing on the implant costs and OR times to reduce costs for all age groups for rTJAs is important to provide cost-effective VBHC.

show abstract

Aseptic revision total hip arthroplasty in the elderly

Cited by 60 publications

References 42 publications

Perioperative factors associated with increased length of stay after revision of metal-on-metal total hip arthroplasty

Perioperative factors associated with increased length of stay after revision of metal-on-metal total hip arthroplasty

The Use of Older Versus Newer Data in the National Surgical Quality Improvement Program Database Influences the Results of Total Hip Arthroplasty Outcomes Studies

Episode-of-Care Costs for Revision Total Joint Arthroplasties by Decadal Age Groups

Contact Info

Product

Resources

About