Comparing Inpatient Complication Rates between Octogenarians and Nonagenarians following Primary and Revision Total Knee Arthroplasty in a Nationally Representative Sample, 2010–2014

We compared the inpatient postoperative complication rates between octogenarians and nonagenarians undergoing primary and revision total knee arthroplasty (TKA). We used the Nationwide Inpatient Sample (NIS) to analyze inpatient admission data from 2010–2014. We compared the rates at which nonagenarians and octogenarians developed each complication following both primary TKA (PTKA) and revision TKA (RTKA). A national estimate of 324,933 patients were included in our study. A total of 313,299 (96.42%) were octogenarians, and 11,634 (3.58%) were nonagenarians. 294,462 (90.62%) underwent PTKA, and 30,471 (9.38%) underwent RTKA. Nonagenarians undergoing PTKA had a higher inpatient mortality rate, and developed sepsis more frequently than octogenarians. Nonagenarians undergoing RTKA had a higher inpatient mortality rate, and developed cardiogenic shock more frequently than octogenarians. In both PTKA and RTKA, nonagenarians received transfusions more frequently, and developed urinary tract infection and acute kidney injury more frequently than octogenarians. In both PTKA and RTKA, nonagenarians sustained a higher inpatient mortality rate than octogenarians. Orthopedic surgeons should counsel nonagenarian patients undergoing both PTKA and RTKA preoperatively about this increased mortality risk, as well as the increased risks of more minor complications like transfusion, urinary tract infection, and acute kidney injury.