Top

Clinical Orthopaedics and Related Research®

Published in:

01-08-2013 | Clinical Research

Older Age Increases Short-term Surgical Complications After Primary Knee Arthroplasty

Authors: Molly C. Easterlin, BA, Douglas G. Chang, MD, PhD, Mark Talamini, MD, David C. Chang, PhD, MPH, MBA

Published in: Clinical Orthopaedics and Related Research® | Issue 8/2013

Abstract

Background

Age is a known risk factor for complications after knee arthroplasty; however, age-related risks for a variety of complications of total and partial knee arthroplasties have not been well quantified.

Questions/purposes

Our study addressed three questions to better understand age-related risk of complications: (1) At what age do different types of complications increase? (2) Is the increase in complications with age resulting from age-related patient comorbidities, sociodemographic characteristics, and surgical conditions? (3) What is the probability of complications at different ages for an average patient?

Methods

The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database from 2005 to 2009 was used to analyze complications for 8950 patients. Complications included NSQIP events, and complications described by the 2003 National Institutes of Health (NIH) consensus statement on total knee arthroplasty as well as 30-day mortality, deep vein thrombosis, return to the operating room, extended length of stay, and technical aspects of the surgery itself. Logistic regression analysis was performed.

Results

Mortality was higher for those aged 85 and older. NSQIP complications increased starting at age 70 years and NIH complications at 85 years. Age remained an independent risk factor for multiple complications with controls. The predicted risk for an average patient ranged from 4% (40–64 years old) to 17% (90 years or older) for NSQIP complications and 2.8% to 8.8% for NIH complications.

Conclusions

Age is an important independent predictor of surgical complications after knee arthroplasties. Surgeons can share these quantified age-specific risks with patients to guide management decisions.

Level of Evidence

Level I, prognostic study. See Instructions for Authors for a complete description of levels of evidence.

American College of Surgeons. ACS National Surgical Quality Improvement Program, program overview. Revised September 18, 2009. Available at: www.facs.org/cqi/outcomes.html. Accessed July 15, 2011.

American College of Surgeons. ACS NSQIP user guide for the 2009 participant use data file. October 2010. Available at: http://site.acsnsqip.org/participant-use-data-file/. Accessed June 2011.

Berend ME, Thong AE, Faris GW, Newbern G, Pierson JL, Ritter MA. Total joint arthroplasty in the extremely elderly: hip and knee arthroplasty after entering the 89th year of life. J Arthroplasty. 2003;18:817–821.PubMedCrossRef

Biau D, Mullins MM, Judet T, Piriou P. Is anyone too old for a total knee replacement? Clin Orthop Relat Res. 2006;448:180–184.PubMed

Bozic KJ, Lau E, Kurtz S, Ong K, Berry DJ. Patient-related risk factors for postoperative mortality and periprosthetic joint infection in Medicare patients undergoing TKA. Clin Orthop Relat Res. 2012;470:130–137.PubMedCrossRef

Gomez CR, Boehmer ED, Kovacs EJ. The aging innate immune system. Curr Opin Immunol. 2005;17:457–462.PubMedCrossRef

Hall BL, Hamilton BH, Richards K, Bilimoria KY, Cohen ME, Ko CY. Does surgical quality improve in the American College of Surgeons National Surgical Quality Improvement Program: an evaluation of all participating hospitals. Ann Surg. 2009;250:363–376.PubMed

Higuera CA, Elsharkawy K, Klika AK, Brocone M, Barsoum WK. 2010 Mid-America Orthopaedic Association Physician in Training Award. Predictors of early adverse outcomes after knee and hip arthroplasty in geriatric patients. Clin Orthop Relat Res. 2011;469:1391–1400.PubMedCrossRef

Huddleston JI, Maloney WJ, Wang Y, Verzier N, Hunt DR, Herndon JH. Adverse events after total knee arthroplasty: a national Medicare study. J Arthroplasty. 2009;24(Suppl):95–100.PubMedCrossRef

10.

Ingraham AM, Richards KE, Hall BL, Ko CY. Quality improvement in surgery: the American College of Surgeons National Surgical Quality Improvement Program approach. Adv Surg. 2010;44:251–267.PubMedCrossRef

11.

Joshi AB, Markovic L, Gill G. Knee arthroplasty in octogenarians: results at 10 years. J Arthroplasty. 2003;18:295–298.PubMedCrossRef

12.

Kurtz SM, Ong KL, Lau E, Bozic KJ, Berry D, Parvizi J. Prosthetic joint infection risk after TKA in the Medicare population. Clin Orthop Relat Res. 2010;468:52–56.PubMedCrossRef

13.

Linton PJ, Dorshkind K. Age-related changes in lymphocyte development and function. Nat Immunol. 2004;5:133–139.PubMedCrossRef

14.

Miller RA. The aging immune system: primer and prospectus. Science. 1996;273:70–74.PubMedCrossRef

15.

NIH Consensus Statement on Total Knee Replacement. NIH Consens State Sci Statements. 2003;20:1–32.

16.

Núñez M, Lozano L, Núñez E, Segur JM, Sastre S, Maculé F, Ortega R, Suso S. Total knee replacement and health-related quality of life: factors influencing long-term outcomes. Arthritis Rheum. 2009;61:1062–1069.PubMedCrossRef

17.

Parvizi J, Mui A, Purtill JJ, Sharkey PF, Hozack WJ, Rothman RH. Total joint arthroplasty: when do fatal or near-fatal complications occur? J Bone Joint Surg Am. 2007;89:27–32.PubMedCrossRef

18.

Peterson CY, Osen HB, Tran Cao HS, Yu PT, Chang DC. The battle of the sexes: women win out in gastrointestinal surgery. J Surg Res. 2011;170:e23–e28.PubMedCrossRef

19.

Plackett TP, Boehmer ED, Faunce DE, Kovacs EJ. Aging and innate immune cells. J Leukoc Biol. 2004;76:291–299.PubMedCrossRef

20.

Plowden J, Renshaw-Hoelscher M, Engleman C, Katz J, Sambhara S. Innate immunity in aging: impact on macrophage function. Aging Cell. 2004;3:161–167.PubMedCrossRef

21.

Pugely AJ, Martin CT, Gao Y, Mendoza-Lattes S, Callaghan JJ. Differences in short-term complications between spinal and general anesthesia for primary total knee arthroplasty. J Bone Joint Surg Am. 2013;95:193–199.PubMedCrossRef

22.

Santaguida PL, Hawker GA, Hudak PL, Glazier R, Mahomed NN, Kreder HJ, Coyte PC, Wright JG. Patient characteristics affecting the prognosis of total hip and knee joint arthroplasty: a systematic review. Can J Surg. 2008;51:428–436.PubMed

23.

Solomon DH, Chibnik LB, Losina E, Huang J, Fossel AH, Husni E, Katz JN. Development of a preliminary index that predicts adverse events after total knee replacement. Arthritis Rheum. 2006;54:1536–1542.PubMedCrossRef

24.

SooHoo NF, Lieberman JR, Ko CY, Zingmond DS. Factors predicting complication rates following total knee replacement. J Bone Joint Surg Am. 2006;88:480–485.PubMedCrossRef

25.

StataCorp. Stata Statistical Software: Release 11. College Station, TX, USA: StataCorp LP; 2009.

26.

US Department of Health and Human Services. Administration on Aging. Aging statistics. Modified September 1, 2011. Available at: www.aoa.gov/aoaroot/aging_statistics/index.aspx. Accessed September 1, 2012.

Title: Older Age Increases Short-term Surgical Complications After Primary Knee Arthroplasty
Authors: Molly C. Easterlin, BA
Douglas G. Chang, MD, PhD
Mark Talamini, MD
David C. Chang, PhD, MPH, MBA
Publication date: 01-08-2013
Publisher: Springer US
Published in: Clinical Orthopaedics and Related Research® / Issue 8/2013
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI: https://doi.org/10.1007/s11999-013-2985-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Older Age Increases Short-term Surgical Complications After Primary Knee Arthroplasty

Abstract

Background

Questions/purposes

Methods

Results

Conclusions

Level of Evidence

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Questions/purposes

Methods

Results

Conclusions

Level of Evidence

Please log in to get access to this content

Other articles of this Issue 8/2013

RETRACTED ARTICLE: Does Incisional Wound VAC after Major Hip Surgery in Obese Pediatric Patients Reduce Wound Infection and Scar Formation? A Pilot Study

Can Selective Soft Tissue Release and Cuboid Osteotomy Correct Neglected Clubfoot?

Novel Biomarkers to Detect Infection in Revision Hip and Knee Arthroplasties

Results of Treatment of Femoroacetabular Impingement in Adolescents with a Surgical Hip Dislocation Approach

Erratum to: Duplicate Submission and Dual Publication: What Is So Wrong With Them?

Editor's Spotlight/Take 5: Nano-ceramic Composite Scaffolds for Bioreactor-based Bone Engineering