Background: Although life expectancy continues to increase worldwide and advances occur in surgical techniques and medical treatment, the chronological age limit for patients to undergo elective major orthopaedic procedures remains a controversial subject. The purpose of this study was to examine the trends in the incidence and in-hospital outcomes of elective major orthopaedic surgery in patients eighty years of age and older in the United States as a whole.
Methods: ICD-9-CM (International Classification of Diseases, 9th Revision, Clinical Modification) codes were used to identify patients at least eighty years of age in the Nationwide Inpatient Sample who underwent spinal fusion, total hip arthroplasty, or total knee arthroplasty from 2000 to 2009. Demographic data regarding the patient and health-care system were retrieved and analyzed.
Results: From 2000 to 2009, there were increasing trends in the age-adjusted incidence of spinal fusion, total hip arthroplasty, and total knee arthroplasty in patients at least eighty years of age (rate per 100,000 per year, 40 to 102 for spinal fusion, 181 to 257 for total hip arthroplasty, and 300 to 477 for total knee arthroplasty; p ≤ 0.001 for each). The overall in-hospital complication rate remained stable over time for spinal fusion and total knee arthroplasty and increased for total hip arthroplasty (9.0% to 10.3%, p = 0.008). The in-hospital mortality rate decreased over time (1.1% to 0.6% for spinal fusion, 0.5% to 0.3% for total hip arthroplasty, and 0.3% to 0.2% for total knee arthroplasty; p < 0.05 for each). The overall in-hospital complication and mortality rates of patients at least eighty years of age were significantly higher than those of patients sixty-five to seventy-nine years of age (p < 0.001 for both).
Conclusions: During the previous decade, the rates of elective major orthopaedic surgical procedures in patients at least eighty years of age increased in the U.S. The in-hospital mortality rates decreased, whereas the overall in-hospital complication rates remained stable or increased. The overall event rates were low, and these elective procedures could be offered to very elderly patients.
Level of Evidence: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Investigation performed at the Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY, and The Graduate University for Advanced Studies, Tachikawa, Tokyo, Japan
Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. None of the authors, or their institution(s), have had any financial relationship, in the thirty-six months prior to submission of this work, with any entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. Also, no author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.
- Copyright © 2014 by The Journal of Bone and Joint Surgery, Incorporated
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