TY - JOUR
T1 - Increased Complications in Octogenarians Undergoing Same-Day Discharge following Total Knee Arthroplasty
T2 - A Matched Cohort Analysis
AU - Berger, Peter Z.
AU - Gu, Alex
AU - Fassihi, Safa C.
AU - Stake, Seth
AU - Bovonratwet, Patawut
AU - Gioia, Casey
AU - Palosaari, Andrew
AU - Campbell, Joshua C.
AU - Thakkar, Savyasachi C.
N1 - Funding Information:
S.C.T. reports support from American Association of Hip and Knee Surgeons: Board or committee member, Arthroplasty Today: editorial or governing board Journal of Arthroplasty: editorial or governing board, KCI: Paid consultant, OrthAlign: Paid consultant. From consulting fees from KCI: Paid consultant, OrthAlign; reports leadership role from American Association of Hip and Knee Surgeons: Board or committee member, Arthroplasty Today: Editorial or governing board, Journal of Arthroplasty. P.B. reports support from Arthroscopy: Editorial or governing board, HSS Journal: Editorial or governing board. Rest authors declare no conflict of interest.
Publisher Copyright:
© 2022 Thieme Publishers Rio. All rights reserved.
PY - 2022
Y1 - 2022
N2 - Same-day discharge pathways in total knee arthroplasty (TKA) are gaining popularity as a means to increase patient satisfaction and reduce overall costs, but these pathways have not been thoroughly evaluated in potentially at-risk populations, such as in patients ≥80 years old. The purpose of this study was to compare 90-day complications and mortality following same-day discharge after primary TKA in patients ≥80 years old and those <80 years old. Patients who underwent unilateral primary TKA, were discharged on postoperative day 0, and had a minimum 90-day follow-up were identified in a national insurance claims database (PearlDiver Technologies) using Current Procedural Terminology code 27447. These patients were stratified into two cohorts based upon age: (1) nonoctogenarians (<80 years old) and (2) octogenarians (≥80 years old). These cohorts were propensity matched based upon sex, Charlson comorbidity index, and obesity status. Univariate analysis was performed to determine differences in 90-day complications and mortality between the two cohorts. In total, 1,111 patients were included in each cohort. Both cohorts were successfully matched, with no observed differences in matched parameters for demographics or comorbidities. There was no significant difference in 90-day mortality between the two cohorts (p = 0.896). However, octogenarians were at significantly increased risk of postoperative atrial fibrillation (20.8 vs. 10.4%; p < 0.001), nonatrial fibrillation arrhythmias (8.4 vs. 5.6%; p = 0.009), pneumonia (4.5 vs. 2.2%; p = 0.002), stroke (3.1 vs. 1.7%; p = 0.037), heart failure (10.5 vs. 7.5%; p = 0.012), and urinary tract infection (UTI; 14.3 vs. 9.4%; p < 0.001) compared with the nonoctogenarian cohort. Relative to matched controls, octogenarians were at significantly increased risk of numerous 90-day medical complications following same-day primary TKA, including cardiopulmonary complications, stroke, and UTI. Clinicians should be cognizant of these complications and counsel patients appropriately when electing to perform same-day TKA in the octogenarian population.
AB - Same-day discharge pathways in total knee arthroplasty (TKA) are gaining popularity as a means to increase patient satisfaction and reduce overall costs, but these pathways have not been thoroughly evaluated in potentially at-risk populations, such as in patients ≥80 years old. The purpose of this study was to compare 90-day complications and mortality following same-day discharge after primary TKA in patients ≥80 years old and those <80 years old. Patients who underwent unilateral primary TKA, were discharged on postoperative day 0, and had a minimum 90-day follow-up were identified in a national insurance claims database (PearlDiver Technologies) using Current Procedural Terminology code 27447. These patients were stratified into two cohorts based upon age: (1) nonoctogenarians (<80 years old) and (2) octogenarians (≥80 years old). These cohorts were propensity matched based upon sex, Charlson comorbidity index, and obesity status. Univariate analysis was performed to determine differences in 90-day complications and mortality between the two cohorts. In total, 1,111 patients were included in each cohort. Both cohorts were successfully matched, with no observed differences in matched parameters for demographics or comorbidities. There was no significant difference in 90-day mortality between the two cohorts (p = 0.896). However, octogenarians were at significantly increased risk of postoperative atrial fibrillation (20.8 vs. 10.4%; p < 0.001), nonatrial fibrillation arrhythmias (8.4 vs. 5.6%; p = 0.009), pneumonia (4.5 vs. 2.2%; p = 0.002), stroke (3.1 vs. 1.7%; p = 0.037), heart failure (10.5 vs. 7.5%; p = 0.012), and urinary tract infection (UTI; 14.3 vs. 9.4%; p < 0.001) compared with the nonoctogenarian cohort. Relative to matched controls, octogenarians were at significantly increased risk of numerous 90-day medical complications following same-day primary TKA, including cardiopulmonary complications, stroke, and UTI. Clinicians should be cognizant of these complications and counsel patients appropriately when electing to perform same-day TKA in the octogenarian population.
KW - complications
KW - octogenarian
KW - same-day discharge
KW - total Joint arthroplasty
KW - total knee arthroplasty
UR - http://www.scopus.com/inward/record.url?scp=85126727525&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85126727525&partnerID=8YFLogxK
U2 - 10.1055/s-0042-1743227
DO - 10.1055/s-0042-1743227
M3 - Article
C2 - 35259763
AN - SCOPUS:85126727525
SN - 1538-8506
JO - Journal of Knee Surgery
JF - Journal of Knee Surgery
ER -