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Elective Major Orthopedic Surgery in Octogenarians

Elective Major Orthopedic Surgery in Octogenarians

By 2030, patients aged 85 and older are projected to account for 2.3% of the United States population, but this figure is expected to nearly double by 2050. There has also been an increasing trend in surgery being performed in the very elderly, but these patients have multiple risk factors that may increase their risk for adverse outcomes after surgery. As a result, there has been some controversy around performing elective surgeries to enhance quality of life (QOL) in this patient population. Typically, major orthopedic procedures like spinal fusion, total hip arthroplasty (THA), and total knee arthroplasty (TKA) are performed electively to alleviate pain and improve QOL. In a study published in the Journal of Bone & Joint Surgery, Hiroyuki Yoshihara, MD, PhD, and colleagues examined the trends and in-hospital outcomes of elective major orthopedic surgeries in patients who were at least 80 years old from 2000 to 2009 using data from the National Inpatient Sample on patients who underwent spinal fusion, THA, and TKA. The analysis included more than 70,000 spinal fusion cases, 233,000 THAs, and 417,000 TKAs. Complication and mortality rates were also compared for patients aged 80 and older with those aged 65 to 79. Incidence, Complications, & Mortality According to the study, there was an increasing trend in the age-adjusted incidence of spinal fusion, THA, and TKA in patients at least 80 years of age from 2000 to 2009. The age-adjusted incidence of spinal fusion increased from 40 to 101 per 100,000 people per year. For THA, the incidence increased from 181 to 257 per 100,000 people. For TKA, the incidence rose from 300 to...
Knee & Hip Arthroplasties: Analyzing the Obesity Effect

Knee & Hip Arthroplasties: Analyzing the Obesity Effect

Published reports have shown that the number of total knee arthroplasty (TKA) procedures performed in the United States more than tripled from 1993 to 2009, while the number of total hip arthroplasty (THA) surgeries doubled during the same timeframe (Figure 1). “In the setting of healthcare reform and cost containment initiatives, increasing surgical volumes have gained greater attention,” says Peter B. Derman, MD, MBA. Several explanations have been proposed regarding the increasing prevalence of total joint arthroplasties, and it is likely that a multitude of interacting factors play a role. These include obesity, the aging population, supplier-induced demand, and changing expectations about the quality of an active lifestyle, among other factors. TKA vs THA Observational studies have described various trends in arthroplasty, examining its economic ramifications as well as projecting future utilization. Dr. Derman and colleagues conducted a study, published in the Journal of Bone & Joint Surgery, to further the understanding of why there has been a more rapid growth in TKA when compared with THA. “The increasing incidence of overweight and obesity was of particular interest to us,” says Dr. Derman. “Studies have linked high BMIs with an elevated risk of knee arthritis, but this relationship is less robust with respect to the hip. We postulated that this differential effect might explain why knee replacement volumes are growing faster than hip replacement volumes.” Weight & Age For the analysis, Dr. Derman and colleagues used data obtained from the Nationwide Inpatient Sample on TKA and THA volume, length of hospital stay, and in-hospital mortality. The sample included details on over 8 million admissions at more than 1,000 hospitals...
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