In what is good news for older Americans, a study has found that mortality and complication rates are going down for total hip (THR) and total knee (TKR) replacement surgeries among patients over 80 years of age. The same is true for older patients having spinal fusion surgeries.
“Based on the results of this study, I think very elderly patients, particularly those with few or no co morbidities, should strongly consider the benefits of these procedures, ” said lead study author Hiroyuki Yoshihara, M.D., Ph.D., an orthopaedic surgeon at State University of New York Downstate Medical Center and Nassau University Medical Center.
According to 2006 U.S. Census Bureau data, Americans who are at least 85 years old represent one of the fastest-growing segments of the population and are expected to account for 2.3% of the total in 2030 and 4.3% in 2050. Reflecting this trend, the number of elective orthopedic surgeries for patients age 80 and older continues to rise.
In the study, researchers analyzed data for patients age 80 and older and those ages 65 to 79. Patient gender, race, comorbidities, complications, mortality, duration of hospital stay, and whether or not patients were discharged to their home or to a rehabilitation facility, and total hospital charges were collected and analyzed.
Of the patients in the Nationwide Inpatient Sample database who were at least 80 years of age, 417, 460 underwent TKR; 233, 277 had a THR; and 70, 203 underwent spinal fusion between 2000 and 2009. For patients between 65 years and 79 years; 1, 868, 983 underwent TKR; 768, 999 had THR and 522, 369 had spinal fusion.
The overall in-hospital complication rate significantly decreased in spine fusion and TKR patients without comorbidity or with a small number of comorbidities. For THR patients aged 80 years or higher and who did not have comorbidity or had a small number of comorbidities, the complication rate remained stable.
The in-hospital mortality rate for patients aged 80 years and older was 0.9% for spinal fusion, 0.5% for THR and 0.3% for TKR. While these rates were higher for patients age 80 and older, when compared to patients aged between 65 years and 79 years, the difference was small for all procedures.
“As life expectancy continues to increase, I hope that very elderly patients who have had inadequate results from exhaustive conservative treatment [of orthopedic problems] undergo the procedures and have better life quality, ” said Yoshihara.
