Mortality same for octogenarians, non-octogenarians after TKA with same-day discharge
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Despite similar 90-day mortality rates with same-day discharge after total knee arthroplasty, risks of diagnosed medical complications were greater for octogenarians vs. non-octogenarians, results of a matched cohort database study showed.
“Our findings suggest that octogenarians are at high risk of being diagnosed with medical complications in the first 90 days after surgery as compared to people younger than 80 [years]. But they are not at increased risk of death,” Peter Z. Berger, BS, said at the American Association of Hip and Knee Surgeons Annual Meeting.
Berger said the findings are consistent with prior literature and suggest advanced age, not only discharge, may increase the medical complications after same-day discharge after primary TKA.
Berger and colleagues used the Humana PearlDiver national insurance claims database to identify 1,111 patients aged equal to greater than 80 years and propensity matched them for demographics and comorbidities to 1,111 patients in the database aged less than 80 years. All patients underwent primary TKA for osteoarthritis (CPT code 27447) and were discharged on postoperative day 0.
Based on the abstract, the two cohorts’ 90-day mortality was not significantly different.
“Notably, mortality was almost identical between the cohorts,” Berger said. “However, cardiac arrythmia, pneumonia, stroke, heart failure and [urinary tract infection] UTI were all found to be statistically significantly different between the cohorts.”
For octogenarians vs. non-octogenarians, respectively, the risks were 20.8% and 10.4% for atrial fibrillation, 8.4% and 5.6% for non-atrial fibrillation arrhythmias, 4.5% and 2.2% for pneumonia, 3.1% and 1.7% for stroke, 10.5% and 7.5% for heart failure and 14.3% and 9.4% for UTI, according to statistics in the abstract.
“The expectations of today’s seniors are likely much different than in the past and while recovery at home, starting on the day of surgery, may improve their quality of life, a detailed discussion regarding the increased risk of medical complications should be included. Careful consideration of urinary catheterization, narcotics usage and medical optimization are particularly important in high-risk cohorts, such as octogenarians. As always, a shared decision-making process should be used to achieve optimal results for patients and providers,” Berger said.
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Berger PZ, et al. Paper 8. Presented at: American Association of Hip and Knee Surgeons Annual Meeting; Nov. 5-8, 2020; Dallas (hybrid meeting).
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