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J Knee Surg 2023; 36(07): 779-784
DOI: 10.1055/s-0042-1743227
Original Article

Increased Complications in Octogenarians Undergoing Same-Day Discharge following Total Knee Arthroplasty: A Matched Cohort Analysis

Peter Z. Berger
1   Department of Orthopaedic Surgery, George Washington School of Medicine and Health Sciences, Washington DC
,
Alex Gu 
1   Department of Orthopaedic Surgery, George Washington School of Medicine and Health Sciences, Washington DC
,
Safa C. Fassihi
1   Department of Orthopaedic Surgery, George Washington School of Medicine and Health Sciences, Washington DC
,
Seth Stake
1   Department of Orthopaedic Surgery, George Washington School of Medicine and Health Sciences, Washington DC
,
Patawut Bovonratwet
2   Department of Orthopaedic Surgery, Hospital for Special Surgery, New York
,
Casey Gioia
1   Department of Orthopaedic Surgery, George Washington School of Medicine and Health Sciences, Washington DC
,
Andrew Palosaari 
1   Department of Orthopaedic Surgery, George Washington School of Medicine and Health Sciences, Washington DC
,
Joshua C. Campbell
1   Department of Orthopaedic Surgery, George Washington School of Medicine and Health Sciences, Washington DC
,
Savyasachi C. Thakkar
2   Department of Orthopaedic Surgery, Hospital for Special Surgery, New York
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Abstract

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.

Keywords

total Joint arthroplasty - total knee arthroplasty - octogenarian - same-day discharge - complications


Publication History

Received: 07 April 2021

Accepted: 09 January 2022

Article published online:
08 March 2022

© 2022. Thieme. All rights reserved.

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