Non-elective hip replacement in nonagenarians and centenarians was associated with significantly higher mortality at <30 days (HR 2.87) compared to elective procedures.
Cohort (n=1,578)
Yes
Does non-elective hip replacement increase mortality and length of stay in nonagenarian and centenarian patients admitted to the ICU compared to elective procedures?
Non-elective hip replacement in nonagenarians and centenarians admitted to the ICU is associated with significantly higher short- and long-term mortality and longer ICU stays compared to elective procedures.
Effect estimate: HR 2.87
Introduction The global population of nonagenarians and centenarians is expected to quadruple by 2050, resulting in increasing numbers of the oldest-old undergoing procedures such as hip replacement to maintain mobility and independence. Despite this trend, evidence on how surgical urgency affects outcomes in this population remains limited. Methods We conducted a retrospective cohort study using data from the ANZICS Adult Patient Database (2010–2023), which captures 98% of intensive care units (ICUs) in Australia and 68% in New Zealand. The study included 1,578 nonagenarian and centenarian patients who underwent non-traumatic hip replacement and were admitted to intensive care. Outcomes examined were mortality at three time intervals (365 days) and ICU and hospital length of stay. Analytical methods included propensity score matching, Cox regression, Kaplan-Meier curves and time-dependent area under the receiver operating characteristic curve analyses to assess the prognostic value of clinical scores and biomarkers. Results Non-elective operation was associated with significantly higher mortality across all time points (HR 2.87 at <30 days; 3.02 at 30–365 days; 1.84 beyond 365 days). It was also linked to a 13.1% longer ICU stay (p=0.034). Acute Physiology and Chronic Health Evaluation III and Sequential Organ Failure Assessment scores showed strong predictive performance for short-term mortality, whereas age and sex had minimal prognostic value. Conclusion Among nonagenarians and centenarians undergoing hip replacement, non-elective procedures were consistently associated with poorer outcomes, including higher mortality and longer ICU stay. Early risk stratification using routine clinical markers, together with proactive goals-of-care discussions, may improve perioperative management in this vulnerable population. Level of evidence Level II Therapeutic/Care Management.
Suh et al. (Wed,) conducted a cohort in Hip replacement requiring ICU admission (n=1,578). Non-elective hip replacement vs. Elective hip replacement was evaluated on Mortality at <30 days (HR 2.87). Non-elective hip replacement in nonagenarians and centenarians was associated with significantly higher mortality at <30 days (HR 2.87) compared to elective procedures.