Orthopedic Surgery Was Successful in Many Older Patients

Death rates and complications from orthopedic surgeries declined in patients 80 and older

(RxWiki News) Many people now live into their 80s and beyond, and part of aging and living well means being able to get around. Orthopedic surgery to help older people get around hasn't always been considered a safe option, but that may now change.

More people 80 and older are undergoing orthopedic procedures and recovering well, a new study showed.

"Learn the treatment options for orthopedic conditions."

Hiroyuki Yoshihara, MD, PhD, of State University of New York Downstate Medical Center in Brooklyn, led this study.

Dr. Yoshihara and colleagues looked at data from the Nationwide Inpatient Sample of people who had orthopedic surgery from 2000 to 2009. They focused on patients who were 80 years old and older.

These researchers found that, of these patients, 79.3 percent had spinal fusion, 68.9 percent underwent total hip replacement and 73.9 percent had total knee replacement. Most patients in this age group who had surgery were 80 to 84 years of age.

Between 2000 and 2009, the in-hospital complication rates for people 80 and older having these surgeries declined slightly for those having spinal fusion (17.5 percent to 16.1 percent) and for those having total knee replacements (9.9 percent to 9.1 percent). Complication rates rose slightly for those having total hip replacement (9 percent to 10.3 percent).

Having comorbidities (other significant disease or conditions) affected how well these older patients fared after surgery. The overall in-hospital complication rate significantly decreased in patients without a comorbidity, or with a small number of comorbidities, for spinal fusion and total knee replacement. It remained stable for total hip replacement.

Death rates were lower for these patients in 2009 than in 2000. By 2009, the death rates for participants who were 80 and older were as follows: an average of 0.6 percent of those who had a spinal fusion (compared to 1.1 percent at the start of the study), 0.3 percent of those who had a hip replacement (down from 0.5 percent) and only 0.2 percent of those who had a knee replacement (reduced from 0.3 percent in 1990).

While the death rate for these older people was higher than for younger people, it was still low, and lower still than years earlier, the study authors noted.

“The present study reinforces the fact that patients at least eighty years of age need to know and accept the higher risk,” the researchers wrote.

The length of time in hospital decreased for all groups, and more people were discharged with home health care, rather than being sent to rehabilitation centers.

“As life expectancy continues to increase, I hope that very elderly patients who have had inadequate results from exhaustive conservative treatment (for various orthopaedic conditions) undergo the procedures and have better life quality,” Dr. Yoshihara said in a press statement.

Deborah Gordon, MD, nutrition expert and operator of an integrative medical practice based in Ashland, OR, said not having the surgery may be worse than undergoing the procedure for those 80 and older.

“Although any surgical (or medical) intervention becomes more risky with advancing age, the morbidity and mortality associated with the described procedures are well worth the risk when weighed against the variable of mobility," Dr. Gordon said.

“In fact, failing to perform a needed orthopedic surgery in an 80 year old just might have a higher morbidity and mortality, than going ahead with the surgery," she told dailyRx News. “When we lose mobility, our muscles and [individual] skills deteriorate, putting us at greater risk for various mental and physical ailments, as well as simple falls. If a knee replacement keeps an elder active, walking, maybe doing yoga — they have not just survived the surgery, they have added years of vitality to their life.”

This study appears in the July issue of the Journal of Bone and Joint Surgery.

The authors of this study reported no conflicts of interest.

Review Date: 
July 21, 2014