Abstract
Background
One of the most important aspects of the transition to outpatient (OP) arthroplasty
is patient selection, with guidance traditionally recommending that OP total knee
arthroplasty (TKA) be reserved for patients <80 years old. However, there are limited
data as to whether older age should really be considered a contraindication to OP-TKA.
The purpose of this study is to assess the risk of complications and readmissions
following OP-TKA in patients ≥80 years old.
Methods
This is a retrospective, propensity-matched cohort study of the National Surgical
Quality Improvement Program database from 2011 to 2019. Patients ≥80 years undergoing
OP (same-day discharge) TKA were propensity matched to patients ≥80 years undergoing
inpatient (IP) TKA based on age, gender, race, body mass index, American Society of
Anesthesiologists classification, functional status, smoking status, anesthetic type,
and medical comorbidities. There were 1,418 patients (709 IPs and 709 OPs) included.
All baseline factors were successfully matched between IP-TKA versus OP-TKA (P ≥ .18 for all). Thirty-day complications, readmissions, reoperations, and mortality
were subsequently analyzed.
Results
Thirty-day readmission rates were identical between patients undergoing IP-TKA and
OP-TKA (3.5% versus 3.5%, P = 1.0). Similarly, there was no significant difference in the incidence of major
complications (2.7% versus 2.0%, P = .38), reoperations (1.3% versus 0.8%, P = .44), or mortalities (0.3% versus 0.3%, P = 1.0) within 30 days.
Conclusion
Octogenarians undergoing OP-TKA had comparable complication rates to similar patients
undergoing IP-TKA. OP-TKA can be performed safely in select octogenarians and age
≥80 years likely does not need to be a uniform contraindication to OP-TKA.
Keywords:
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Article info
Publication history
Published online: August 17, 2022
Accepted:
August 7,
2022
Received in revised form:
August 3,
2022
Received:
June 11,
2022
Footnotes
One or more of the authors of this paper have disclosed potential or pertinent conflicts of interest, which may include receipt of payment, either direct or indirect, institutional support, or association with an entity in the biomedical field which may be perceived to have potential conflict of interest with this work. For full disclosure statements refer to https://doi.org/10.1016/j.arth.2022.08.013.
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