Study shows orthopedic surgery is safer for patients over age 80

The number of people over 65 years old in America has increased at a faster rate than any other population age group – 15.1 percent for those over 65 years and 9.7 percent for those less than 65 years.Additionally, 26.3 percent of those over age 65 are 80 or older, according to the 2010 Census. A new study shows that a growing number of U.S. patients aged 80 and older are choosing to have orthopedic surgery. Furthermore, the study proved orthopedic surgeries are becoming safer for these seniors.

"Trends in the Incidence and In-Hospital Outcomes of Elective Major Orthopaedic Surgery in Patients Eighty Years of Age and Older in the United States from 2000 to 2009," which was published in the Journal of Bone and Joint Surgery and conducted by the American Academy of Orthopedic Surgeons, examined trends in the incidences and in-hospital outcomes of elective major orthopedic surgery for U.S. patients by using International Classification of Diseases, 9th Revision, Clinical Modification codes to identify patients over the age of 80 who recently had a spinal fusion, total hip arthroplasty or total knee arthroplasty. The study then collected these electronic health care records and analyzed the correlations.

"Based on the results of this study, I think very elderly patients, particularly those with few or no comorbidities, should strongly consider the benefits of these procedures," lead study author Hiroyuki Yoshihara, M.D., Ph.D., an orthopedic surgeon at State University of New York Downstate Medical Center and Nassau University Medical Center, told the American Academy of Orthopedic Surgeons.

The results
The study found an increase in age-adjusted trends for orthopedic surgery. Specifically, per 100,000 patients over the age of 80, patient rates increased from 40 to 102  for spinal fusion, 181 to 257 for total knee arthroplasty and 300 to 477 for total hip arthroplasty. Complication rates for in-hospital spinal fusions and total hip arthroplasty remained stable. These rates slightly increased in total knee arthroplasty, from 9 percent to 10.3 percent. However, in-hospital mortality rates decreased in each category over the nine-year period. Spinal fusion rates decreased from 1.1 percent to 0.6 percent, while rates decreased from 0.5 percent to 0.3 percent for total hip and from 0.3 percent to 0.2 percent for total knee arthroplasty. The study also found that in-hospital complication and mortality rates of patients at least 80 years old were higher than patients between 65 and 79 years old, but not to a significant degree.

The study's conclusion is that despite low overall rates of elective orthopedic surgeries, patients over the age of 80 are more likely to participate in the procedures, and mortality rates associated with this age group and these surgeries have decreased.

"I think this finding may reflect improvements in medical treatment for complications during the last decade," Yoshihara told the AAOS. "As life expectancy continues to increase, I hope that very elderly patients who have had inadequate results from exhaustive conservative treatment (for various orthopedic conditions) undergo the procedures and have better life quality."