Complications and Readmissions After Total Knee Replacement in Octogenarians and Nonagenarians

Abstract

Introduction:From 2000 to 2010, the cohort of patients aged 85 to 94 years had the fastest growth rate increasing in size by approximately 30%. The need for total knee arthroplasty (TKA) continues to increase with a larger percentage of patients older than 80 years requiring TKA. The purpose of our study was to examine the rate and risks of 30-day complications and unplanned readmission in patients older than 80 years.Materials and Methods:The National Surgical Quality Improvement Project database for the years 2008 to 2014 was queried for patients older than 80 years undergoing TKA. The risks of major complications, minor complications, bleeding occurrences, unplanned readmissions, and deaths over a 30-day period were examined using univariate and multivariate analyses.Results:Overall, 12 026 patients were included for analysis. In all, 422 (3.5%) experienced a major complication, 2316 (19.3%) experienced a minor complication, 2074 (17.2%) had a bleeding occurrence requiring transfusion, and 566 (4.7%) experienced an unplanned readmission. Thirty-eight (0.3%) deaths were recorded. There were no significant risk factors for major complications. Patients with an American Society of Anesthesiologists (ASA) >2 (odds ratio [OR]: 1.43 [1.239-1.651]), patients older than 84 years (OR: 1.240 [1.072-1.434]), and patients receiving general anesthesia (OR: 1.191 [1.035-1.370]) had increased risks of minor complications. Patients with a body mass index >30 (OR: 0.640 [0.532-0.770]) and men (OR: 0.815 [0.706-0.941]) had reduced rates of minor complications. Increased risk of unplanned readmission occurred in patients with chronic obstructive pulmonary disease (OR: 1.694 [1.007-2.850]) and congestive heart failure (OR: 3.030 [1.121-8.192]). Increased risk of death was seen in patients with an ASA >2 (OR: 8.9 [1.144-69.82]).Discussion/Conclusion:Elderly patients undergoing TKA have high complication and readmission rates. Surgeons should convey these increased risk factors and rates of complications in elective TKAs to their elderly patients and work with primary care physicians to mitigate these risks.

The long-term results of total knee arthroplasty in octogenarian

“…Yohe et al studied the complication rate of octogenarians according to the American College of Surgeons National Surgical Quality Improvement Project (ACS-NSQIP) database in USA. 28 Rate of major complications such as stroke, myocardial infarction, sepsis and revision surgery was found to be 3.5%, with overall rate of revision 1.2%. 4.7% patients presented with unplanned readmissions within 30 days.…”

Risk Factors for Readmission After Knee Arthroplasty Based on Predictive Models: A Systematic Review

“…For example, some studies used age as continuous variable [22,42], whereas others created bins for age as a categorical variable as per differing cutoff points [24e27,32]. Similarly, some studies presented ORs for 30-day readmission as an outcome [10,11,21,26,30,32,33,34,36], whereas others for 90-day readmission as an outcome [23e25, 35,43].…”

Hemiarthroplasty or total elbow arthroplasty for unreconstructable distal humeral fractures in patients aged over 65 years

“…[43][44][45] Large differences in pooled complications will be seen depending on which complications are included for analysis. 46 We were unable to extract the number of complications per person, and as some patients will have had more than one complication, our results may represent an inflated figure.…”