{"title":"Total Shoulder Arthroplasty in Octogenarians and Nonagenarians: A Database Study of 33,089 Patients.","authors":"Dafang Zhang, Bassem Elhassan","doi":"10.5435/JAAOS-D-23-00800","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>The utilization of total shoulder arthroplasty (TSA) in an aging population continues to rise, but the perioperative risk profile of TSA in the very elderly is not well-described. The objective of this study was to quantify the risk profile of 30-day perioperative adverse events after TSA in octogenarians and nonagenarians using a large national database over a recent 10-year period.</p><p><strong>Methods: </strong>The National Surgical Quality Improvement Program database was queried for TSA from 2011 to 2020. Patients were stratified into three age groups: (1) age < 80 years, (2) 80 years ≤ age < 90 years (\"octogenarians\" in this study), and (3) age ≥ 90 years (\"nonagenarians\" in this study). The primary outcome was 30-day complication, and secondary outcome variables included 30-day readmission, revision surgery, and mortality. Multivariable logistic regression analyses adjusted for relevant comorbidities were done.</p><p><strong>Results: </strong>The cohort included 33,089 patients who underwent TSA, including 28,543 patients younger than 80 years, 4,334 octogenarians, and 212 nonagenarians. Complication rates were 4% in patients younger than 80 years, 8% in octogenarians, and 16% in nonagenarians. Readmission rates were 3% in patients younger than 80 years, 4% in octogenarians, and 7% in nonagenarians. Mortality rates were 0.1% in patients younger than 80 years, 0.4% in octogenarians, and 2% in nonagenarians. Revision surgery was not markedly different among age groups. In the adjusted multivariable logistic regression analysis, compared with patients younger than 80 years, octogenarians had 1.9-times higher odds of complications and 1.5-times higher odds of readmission, and nonagenarians had 7.1-times higher odds of complications and 2.2-times higher odds of readmission.</p><p><strong>Discussion: </strong>Our findings are germane to preoperative counseling in very elderly patients considering TSA, to balance potential improvements in quality of remaining life years against the risk of adverse events.</p><p><strong>Level of evidence: </strong>Level IV Prognostic.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":""},"PeriodicalIF":2.6000,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of the American Academy of Orthopaedic Surgeons","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.5435/JAAOS-D-23-00800","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
引用次数: 0
Abstract
Background: The utilization of total shoulder arthroplasty (TSA) in an aging population continues to rise, but the perioperative risk profile of TSA in the very elderly is not well-described. The objective of this study was to quantify the risk profile of 30-day perioperative adverse events after TSA in octogenarians and nonagenarians using a large national database over a recent 10-year period.
Methods: The National Surgical Quality Improvement Program database was queried for TSA from 2011 to 2020. Patients were stratified into three age groups: (1) age < 80 years, (2) 80 years ≤ age < 90 years ("octogenarians" in this study), and (3) age ≥ 90 years ("nonagenarians" in this study). The primary outcome was 30-day complication, and secondary outcome variables included 30-day readmission, revision surgery, and mortality. Multivariable logistic regression analyses adjusted for relevant comorbidities were done.
Results: The cohort included 33,089 patients who underwent TSA, including 28,543 patients younger than 80 years, 4,334 octogenarians, and 212 nonagenarians. Complication rates were 4% in patients younger than 80 years, 8% in octogenarians, and 16% in nonagenarians. Readmission rates were 3% in patients younger than 80 years, 4% in octogenarians, and 7% in nonagenarians. Mortality rates were 0.1% in patients younger than 80 years, 0.4% in octogenarians, and 2% in nonagenarians. Revision surgery was not markedly different among age groups. In the adjusted multivariable logistic regression analysis, compared with patients younger than 80 years, octogenarians had 1.9-times higher odds of complications and 1.5-times higher odds of readmission, and nonagenarians had 7.1-times higher odds of complications and 2.2-times higher odds of readmission.
Discussion: Our findings are germane to preoperative counseling in very elderly patients considering TSA, to balance potential improvements in quality of remaining life years against the risk of adverse events.
期刊介绍：
The Journal of the American Academy of Orthopaedic Surgeons was established in the fall of 1993 by the Academy in response to its membership’s demand for a clinical review journal. Two issues were published the first year, followed by six issues yearly from 1994 through 2004. In September 2005, JAAOS began publishing monthly issues.
Each issue includes richly illustrated peer-reviewed articles focused on clinical diagnosis and management. Special features in each issue provide commentary on developments in pharmacotherapeutics, materials and techniques, and computer applications.
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