Abstract
Background
Prior studies have shown hypertensive patients to be at an increased risk of postoperative complications following various surgeries, including revision total knee arthroplasty (rTKA). However, whether these risks are compounded in octogenarian patients has not yet been well explored. The purpose of this study was to analyze whether hypertensive octogenarians, aged 80 to 89, undergoing rTKA are at an increased risk of postoperative complications relative to the younger hypertensive geriatric population aged 65 to 79.
Methods
A national database was used to collect data for all hypertensive patients who underwent rTKA from 2006 to 2018. Patients were stratified into an aged 65 to 79 cohort and an aged 80 to 89 cohort. Demographics, medical comorbidities, and postoperative complications were compared between the two cohorts. Bivariate and multivariate analyses were performed.
Results
Of the 6,599 hypertensive patients who underwent rTKA, 5,477 (83.0%) patients were in the aged 65 to 79 group and 1,122 (17.0%) patients were in the aged 80 to 89 group. Following adjustment to control for demographic and comorbidity data, relative to patients in the 65 to 79 age group, hypertensive patients who were 80–89 years old had an increased risk of unplanned reintubation (OR 3.52; p = 0.008), urinary tract infection (OR 2.08; p = 0.011), postoperative transfusion (OR 1.90; p < 0.001), myocardial infarction (OR 2.55; p = 0.017), and extended length of hospital stay (OR 1.77; p < 0.001).
Conclusion
Hypertensive octogenarian patients undergoing rTKA have an increased risk of an extended length of stay and other postoperative complications relative to their younger hypertensive geriatric counterparts. Orthopaedic surgeons should consider a multi-disciplinary approach to managing hypertension in these octogenarian patients prior to surgery to minimize this risk. However, even with this risk, an octogenarian age should not be used independently in evaluating if a hypertensive geriatric patient is a safe rTKA candidate.
Keywords: Revision total knee arthroplasty, Hypertension, Octogenarians, Geriatrics, Complications
1. Introduction
Hypertension is the principal cause of cardiovascular disease and premature death worldwide. It is estimated to affect approximately 31% of the world's population and continues to increase in prevalence.1 Several risk factors for developing hypertension include age, obesity, and diabetes.2 Proper pharmacological and non-pharmacological management of hypertension is needed for preventing long-term cardiovascular and cerebrovascular disease.3 Importantly, patients with preoperative diastolic blood pressures of 110 mmHg or higher have been shown to be at a greater risk of numerous postoperative complications, including myocardial ischemia, arrhythmias, and renal failure.4 Thus, recent studies have aimed to explore the influence of hypertension on surgical outcomes in patients across various specialties.
Prior literature has shown that patients with hypertension, including those of geriatric age, tend to have worse surgical outcomes.2,5, 6, 7, 8, 9, 10, 11, 12, 13 In a study that looked at 1,266 patients with a median age of 70 years undergoing radical nephroureterectomy (RNU), hypertension was found to be associated with major complications (p < 0.002).11 Additionally, Aronson et al. analyzed patients undergoing elective coronary artery bypass grafting (CABG) surgery and found that isolated systolic hypertension (SBP >140 mmHg) independently increased the risk for an adverse outcome (death, left ventricular dysfunction, renal failure or insufficiency, and CNS dysfunction).13 Furthermore, in patients age 85 years or older undergoing elective surgery (orthopaedic and non-orthopaedic), hypertension was found to be an independent risk factor for escalation of care in living conditions.9 Analogous findings in orthopaedic literature have also been found.14, 15, 16, 17, 18 In a study that looked at 46,322 patients with total knee arthroplasty (TKA) or total hip arthroplasty (THA), age over 80 years and hypertension requiring medication were two of the three most significant risk factors for postoperative cardiac complications.14 Additionally, hypertensive patients (mean age 61.3 years) with an average systolic blood pressure of 150.1 mmHg were found to have an increased risk for prolonged wound discharge following primary THA relative to normotensive patients.15
In summary, these aforementioned studies have shown that hypertensive geriatric and non-geriatric patients undergoing THA, TKA, and other surgeries are at an increased risk for post-operative morbidity.14, 15, 16, 17, 18 However, several of these studies are severely limited in that they did not stratify by age within the geriatric population (65 years and older).14, 15, 16, 17, 18 There are many physiologic and functional differences that exist within this cohort that need to be considered as they may influence risks and outcomes. Such differences in risk for post-operative morbidity and mortality between octogenarians and their younger geriatric counterparts has been demonstrated in many prior studies.5,19, 20, 21, 22, 23 Gray et al. also examined the risk of complications in octogenarians using 19,585 patients who underwent open reduction internal fixation (ORIF) for ankle fractures. The authors found that patients aged 80 years and above had a higher risk of wound complications, pulmonary complications, and renal complications within 30-days compared to their younger counterparts following ORIF for ankle fractures.24 Therefore, it is critical to explore potential differences in post-operative morbidity and mortality within the hypertensive geriatric population following various orthopaedic surgeries, such as revision TKA (rTKA). Thus, the purpose of this study was to analyze whether there are any differences in risk for thirty-day morbidity and mortality following rTKA in hypertensive octogenarians (aged 80–89 years) compared to their younger hypertensive geriatric counterparts (aged 65–79 years).
2. Methods
From the years 2006–2018, data were collected through the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database for this retrospective study. This database has been well-described in the existing literature.6,7,25, 26, 27
Patients who underwent rTKA were identified using Current Procedural Terminology codes 27486 and 27487. In order to analyze a homogenous cohort of patients, only aseptic revision cases were included in the analysis by excluding cases with a primary diagnosis of prosthetic joint infection by International Classification Diseases (ICD)-9 and ICD-10 codes. Only patients with a diagnosis of hypertension were included in the analysis. In this database, hypertension was defined as a blood pressure of 140/90 mmHg or above with the use of an antihypertensive medication within 30 days prior to the operation.28 Patients were excluded if they had missing baseline data, including their sex, race, or American Society of Anesthesiologists (ASA) score. Patients were also excluded if their age was <65 or if they presented with disseminated cancer. Patients were further excluded if they had other procedures performed during their visit for rTKA. Two patient cohorts were stratified in this study: patients who were 65–79 years old and patients who were 80–89 years old.
Collected data regarding patients' demographics, clinical characteristics, and comorbidities are shown in Table 1, Table 2. The thirty-day outcomes assessed in this study are shown in Table 3. Based on previous studies, extended length of hospital stay was defined as more than 3 days.29,30 To conduct statistical analyses, IBM SPSS 28 (SPSS Inc., Armonk, NY) software was used. Data on patient demographics, comorbidities, and complications were analyzed between the two different age cohorts using bivariate analyses. Pearson's Chi-squared test and one-way analysis of variance were utilized where appropriate. To control for confounding variables, demographics and comorbidities were included in the multivariate analyses for p-values < 0.20.31,32 Multivariable logistic regression analyses were performed to identify the independent risk factors for postoperative complications. In this study, a p-value of <0.05 was statistically significant.
Table 1.
Demographics and clinical characteristics among hypertensive patients undergoing revision total knee arthroplasty.
| Demographics | 65–79 years old (N = 5,477) | 80–89 years old (N = 1,122) | P-Value |
|---|---|---|---|
| Agea (year) | 71.18 ± 4.21 | 83.08 ± 2.56 | < 0.001c |
| Sexb | 0.602d | ||
| Male | 2,228 (40.7) | 447 (39.8) | |
| Female | 3,249 (59.3) | 675 (60.2) | |
| Raceb | 0.002d | ||
| White | 4,406 (80.4) | 936 (83.4) | |
| Black | 693 (12.7) | 101 (9.0) | |
| Hispanic | 277 (5.1) | 53 (4.7) | |
| Indian | 13 (0.2) | 2 (0.2) | |
| Asian | 66 (1.2) | 25 (2.2) | |
| Hawaiian | 22 (0.4) | 5 (0.4) | |
| BMIa (kg/m2) | 33.79 ± 6.61 | 30.34 ± 5.93 | < 0.001c |
| ASA Classificationb | < 0.001d | ||
| ASA I | 8 (0.1) | 0 (0.0) | |
| ASA II | 1,656 (30.2) | 236 (21.0) | |
| ASA III | 3,580 (65.4) | 806 (71.8) | |
| ASA IV | 232 (4.2) | 80 (7.1) | |
| ASA V | 1 (0.0) | 0 (0.0) | |
Bolding equals significance p < 0.05.
BMI, body mass index; ASA, American Society of Anesthesiologists.
The values represent the mean and the standard deviation.
The values represent the number of patients, with the percentage indicated in parentheses.
Analysis of variance.
Pearson's chi-squared test.
Table 2.
Comorbidities among hypertensive patients undergoing revision total knee arthroplasty.
| Comorbiditiesb | 65–79 years old (N = 5,477) | 80–89 years old (N = 1,122) | P-Valuea |
|---|---|---|---|
| COPD | 316 (5.8) | 80 (7.1) | 0.080 |
| CHF | 55 (1.0) | 17 (1.5) | 0.133 |
| Renal failure | 3 (0.1) | 2 (0.2) | 0.171 |
| Dialysis | 25 (0.5) | 4 (0.4) | 0.645 |
| Steroid use | 249 (4.5) | 52 (4.6) | 0.897 |
| Weight loss | 13 (0.2) | 6 (0.5) | 0.090 |
| Bleeding disorder | 289 (5.3) | 87 (7.8) | 0.001 |
| Smoker | 285 (5.2) | 21 (1.9) | < 0.001 |
| Preoperative transfusion | 25 (0.5) | 24 (2.1) | < 0.001 |
| Functional status | < 0.001 | ||
| Independent | 5,244 (96.2) | 1,010 (90.8) | |
| Partially dependent | 198 (3.6) | 94 (8.5) | |
| Totally dependent | 11 (0.2) | 8 (0.7) | |
| DM status | < 0.001 | ||
| No DM | 3,888 (71.0) | 869 (77.5) | |
| Noninsulin-dependent DM | 1,119 (20.4) | 170 (15.2) | |
| Insulin-dependent DM | 470 (8.6) | 83 (7.4) | |
| Dyspnea | 0.004 | ||
| No dyspnea | 5,038 (92.0) | 1,002 (89.3) | |
| Moderate exertion | 420 (7.7) | 118 (10.5) | |
| At rest | 19 (0.3) | 2 (0.2) | |
| Anesthesia type | 0.559 | ||
| General | 3,344 (61.1) | 664 (59.2) | |
| Neuraxial | 1,466 (26.8) | 330 (29.4) | |
| Regional | 117 (2.1) | 26 (2.3) | |
| MAC | 537 (9.8) | 100 (8.9) | |
Bolding equals significance p < 0.05.
COPD, chronic obstructive pulmonary disease; CHF, congestive heart failure; DM, diabetes mellitus; MAC, monitored anesthetic care.
Pearson's chi-squared test.
The values represent the number of patients, with the percentage indicated in parentheses.
Table 3.
Bivariate analysis of postoperative complications of hypertensive patients following revision total knee arthroplasty.
| 30-Day Outcomesb | 65–79 years old (N = 5,477) | 80–89 years old (N = 1,122) | P-Valuea |
|---|---|---|---|
| Operative Complications | |||
| Superficial Surgical Site Infection | 22 (0.4) | 7 (0.6) | 0.305 |
| Deep Surgical Site Infection | 27 (0.5) | 6 (0.5) | 0.857 |
| Organ Space Infection | 51 (0.9) | 9 (0.8) | 0.678 |
| Wound Dehiscence | 20 (0.4) | 8 (0.7) | 0.102 |
| Non-Operative Complications | |||
| Pneumonia | 29 (0.5) | 9 (0.8) | 0.272 |
| Unplanned Reintubation | 13 (0.2) | 10 (0.9) | < 0.001 |
| Pulmonary Embolism | 28 (0.5) | 6 (0.5) | 0.920 |
| Renal Insufficiency | 14 (0.3) | 3 (0.3) | 0.944 |
| Urinary Tract Infection | 51 (0.9) | 19 (1.7) | 0.023 |
| Postoperative Transfusion | 518 (9.5) | 226 (20.1) | < 0.001 |
| Deep Vein Thrombosis | 38 (0.7) | 17 (1.5) | 0.006 |
| Myocardial Infarction | 19 (0.3) | 13 (1.2) | < 0.001 |
| Sepsis | 40 (0.7) | 11 (1.0) | 0.384 |
| Extended Length of Stay (>3 days) | 1,272 (23.2) | 415 (37.0) | < 0.001 |
| Readmission | 295 (7.2) | 67 (8.0) | 0.419 |
| Reoperation | 189 (3.5) | 40 (3.6) | 0.849 |
| Death | 18 (0.3) | 12 (1.1) | < 0.001 |
Bolding equals significance p < 0.05.
Pearson's chi-squared test.
The values represent the number of patients, with the percentage indicated in parentheses.
3. Results
3.1. Demographics
In total, 6,599 hypertensive patients who underwent rTKA were included in the analysis after applying the exclusion criteria. 5,477 (83.0%) hypertensive patients were in the aged 65 to 79 group and 1,122 (17.0%) hypertensive patients were in the aged 80 to 89 cohort. Relative to patients aged 65 to 79, those with hypertension who were 80–89 years old were more likely to have a lower body mass index (30.3 vs 33.8 kg/m2; p < 0.001) and have an ASA class of IV (7.1% vs 4.2%; p < 0.001). Hypertensive patients aged 65 to 79 were more likely to be Black (12.7% vs 9.0%; p = 0.002) (Table 1).
3.2. Comorbidities
Compared to hypertensive patients in the aged 65 to 79 cohort, patients who were aged 80 to 89 were more likely to have comorbidities, such as bleeding disorders (7.8% vs 5.3%; p = 0.001), preoperative transfusion requirement (2.1% vs 0.5%; p < 0.001), and have dyspnea on moderate exertion (10.5% vs 7.7%; p = 0.004). Hypertensive patients who were aged 65 to 79 were more likely to be smokers (5.2% vs 1.9%; p < 0.001), diabetics (29.0% vs 22.6%; p < 0.001), and have an independent functional status (96.2% vs 90.8%; p < 0.001) (Table 2). There were no differences in mean operative time for patients in the aged 65 to 79 cohort compared to patients in the aged 80 to 89 group (134.1 vs. 131.4 min; p = 0.194).
3.3. Complications
On bivariate analysis of complications following rTKA in hypertensive patients, patients who were aged 80 to 89 were more likely to develop unplanned reintubation (0.9% vs 0.2%; p < 0.001), urinary tract infections (UTIs) (1.7% vs 0.9%; p = 0.023), postoperative transfusion requirement (20.1% vs 9.5%; p < 0.001), deep vein thrombosis (1.5% vs 0.7%; p = 0.006), myocardial infarction (1.2% vs 0.3%; p < 0.001), extended hospital length of stay of more than 3 days (37.0% vs 23.2%; p < 0.001), and mortality (1.1% vs 0.3%; p < 0.001) compared to patients aged 65 to 79 (Table 3).
Following adjustment on multivariate logistic regression analysis, hypertensive patients who were 80–89 years old had an increased risk of unplanned reintubation (OR 3.52; 95% CI 1.39 to 8.93; p = 0.008), UTIs (OR 2.08; 95% CI 1.18 to 3.64; p = 0.011), postoperative transfusion (OR 1.90; 95% CI 1.57 to 2.29; p < 0.001), myocardial infarction (OR 2.55; 95% CI 1.18 to 5.49; p = 0.017), and extended length of stay greater than 3 days (OR 1.77; 95% CI 1.53 to 2.05; p < 0.001) (Table 4).
Table 4.
Multivariate analysis of postoperative complications of hypertensive patients following revision total knee arthroplasty.
| 80–89 years old (versus 65–79 years old) 30-Day Outcomes |
Odds Ratio | 95% CI | P-Value | |
|---|---|---|---|---|
| Unplanned Reintubation | 3.523 | 1.391 | 8.925 | 0.008 |
| Urinary Tract Infection | 2.075 | 1.182 | 3.640 | 0.011 |
| Postoperative Transfusion | 1.898 | 1.572 | 2.292 | < 0.001 |
| Deep Vein Thrombosis | 1.819 | 0.976 | 3.391 | 0.060 |
| Myocardial Infarction | 2.548 | 1.182 | 5.493 | 0.017 |
| Extended Length of Stay (>3 days) | 1.771 | 1.527 | 2.054 | < 0.001 |
| Death | 1.568 | 0.673 | 3.653 | 0.297 |
Bolding equals significance p < 0.05.
CI, confidence interval.
3.4. Hypertension vs. No hypertension
A subset analysis was done comparing patients aged 80–89 with hypertension to patients aged 80–89 without hypertension to assess whether non-hypertensive patients had more favorable outcomes. Our results showed that there were no differences in postoperative complications or length of stay between those with and those without hypertension in this age group (Table 5).
Table 5.
Bivariate analysis of postoperative complications of 80–89 Years old patients following revision total knee arthroplasty.
| 30-Day Outcomesb | No Hypertension (N = 283) | Hypertension (N = 1,122) | P-Valuea |
|---|---|---|---|
| Operative Complications | |||
| Superficial Surgical Site Infection | 3 (1.1) | 7 (0.6) | 0.435 |
| Deep Surgical Site Infection | 0 (0.0) | 6 (0.5) | 0.218 |
| Organ Space Infection | 1 (0.4) | 9 (0.8) | 0.422 |
| Wound Dehiscence | 1 (0.4) | 8 (0.7) | 0.498 |
| Non-Operative Complications | |||
| Pneumonia | 2 (0.7) | 9 (0.8) | 0.871 |
| Unplanned Reintubation | 0 (0.0) | 10 (0.9) | 0.111 |
| Pulmonary Embolism | 2 (0.7) | 6 (0.5) | 0.731 |
| Renal Insufficiency | 0 (0.0) | 3 (0.3) | 0.384 |
| Urinary Tract Infection | 5 (1.8) | 19 (1.7) | 0.932 |
| Postoperative Transfusion | 47 (16.6) | 226 (20.1) | 0.179 |
| Deep Vein Thrombosis | 3 (1.1) | 17 (1.5) | 0.564 |
| Myocardial Infarction | 1 (0.4) | 13 (1.2) | 0.223 |
| Sepsis | 3 (1.1) | 11 (1.0) | 0.904 |
| Extended Length of Stay (>3 days) | 100 (35.3) | 415 (37.0) | 0.606 |
| Readmission | 10 (5.0) | 67 (8.0) | 0.149 |
| Reoperation | 6 (2.1) | 40 (3.6) | 0.222 |
| Death | 1 (0.4) | 12 (1.1) | 0.261 |
Bolding equals significance p < 0.05.
Pearson's chi-squared test.
The values represent the number of patients, with the percentage indicated in parentheses.
4. Discussion
Hypertensive patients have been shown to have an increased risk of complications, longer length of hospital stay, and mortality following various surgeries compared to their non-hypertensive counterparts.8,11,12,14, 15, 16, 17, 18 However, whether or not these risks disproportionately affect octogenarians compared to younger geriatric patients following rTKA has not yet been studied. After controlling for demographics and comorbidities, this study showed for the first time that hypertensive octogenarian patients undergoing rTKA have an increased risk of extended length of stay and other postoperative complications relative to their younger hypertensive geriatric counterparts.
This study's finding of an increased risk of postoperative complications and prolonged hospital stay following rTKA for hypertensive octogenarians is consistent with prior orthopaedic literature exploring the influence of hypertension on post-surgical outcomes. Schick et al. found that a history of hypertension was an independent risk factor for any complication as well as major morbidity or mortality following ORIF for distal radius fractures.16 Likewise, hypertension was found to be an independent risk factor for developing a postoperative complication or requiring an inpatient stay following THA in a study of 34,416 Medicare-aged patients with a mean age of 73 years.17 Furthermore, Dy et al. showed that hypertension is an independent risk factor for myocardial infarction following THA and TKA.18 Importantly, studies have also shown that postoperative complications disproportionately affect older patients as opposed to their younger counterparts. For example, in a study looking at 886 patients undergoing ORIFs for closed, non-polytraumatic, non-pilon ankle fractures, risk for postoperative infection among older patients above 50 years with hypertension (RR = 3.52, p = 0.004) was greater than the risk for younger patients (RR = 2.46, p = 0.017).10 As seen with these prior studies, although the impact of hypertension on postoperative complications of older patients undergoing surgery is well documented, there is a limited literature about whether this risk increases for octogenarians relative to their younger geriatric counterparts.
However, there are several orthopaedic studies that are in contrary to this study's findings of an increased risk for postoperative complications in hypertensive octogenarians. In a systematic review and meta-analysis that examined 1,651 fractures managed by ORIF, hypertension was not found to significantly increase the risk of wound complications (p > 0.05).33 Likewise, a history of hypertension was not found to increase postoperative mortality in a study of patients undergoing primary elective THA (majority of patients age 65 years or older).34 A study that looked at thirty-day postoperative complications and mortality in unilateral TKA patients (mean age of 67 years) found that while hypertension was the most common medical comorbidity (70.0%), it was not an independent predictor of major or minor local or systemic complications.35 Despite the findings from these aforementioned studies being in contrast to this study's results, none are in direct disagreement with this study's finding of hypertensive octogenarians having an increased risk of postoperative complications and a longer length of stay following rTKA relative to younger geriatric patients.
The increased length of stay risk in hypertensive octogenarians found in this study may partly be due to poor wound healing in these patients. Good cardiovascular health is essential for effective wound healing following surgery. Common cardiovascular risk factors, including hypertension, adversely affect the endothelium through various mechanisms including an increased production of reactive oxygen species, leading to poor wound healing.36 It is possible that with increasing age among the geriatric population, blood pressures are not being managed as optimally due to personal, social, and biological factors, thereby worsening their cardiovascular health and thus wound healing capacities. In addition, there tends to be a greater incidence of other comorbidities not found in the NSQIP database with increasing age, which may exacerbate the effect of hypertension on wound healing and postoperative health.37
As is the case with other studies, this study is not without limitations. Using the large NSQIP database creates numerous inherent limitations. Miscoding or omission of data points, including procedural codes or complications, is known to occur in large databases despite attempts at quality control. In addition, this study only considered 30-day postoperative complications and mortality. The utilization of a longer period, such as 60 days or 180 days, could reveal other significant differences in postoperative complications, readmission rates, or mortality in the octogenarian cohort relative to their younger geriatric counterparts. As a result, we may be underestimating the true rates. Future studies should consider longer periods when evaluating postoperative complications and mortality. Another limitation is that the NSQIP database does not report on the use of torniquets, therefore we are unable to evaluate its impact on wound healing, deep vein thrombosis, and postoperative blood transfusion. Future studies should examine how the use of torniquets can impact postoperative complications. A further potential limitation of this study is that the degree of elevated blood pressure was not considered, as variations in risk may exist based on stage of hypertension. Future studies should focus on evaluating the different stages of hypertension and its impact on postoperative complications. Moreover, only hypertensive patients on antihypertensive medication were included in the study. Uncontrolled hypertension in octogenarians might lead to more prominent postoperative complications relative to their younger geriatric patients and thus needs to be further studied. Despite these limitations, this study is the first retrospective study with a large sample size to analyze whether or not hypertensive octogenarians undergoing rTKA are at an increased risk of thirty-day postoperative morbidity and mortality.
5. Conclusion
Octogenarians with hypertension are at an increased risk for postoperative complications and a longer length of stay following rTKA relative to their younger hypertensive geriatric patients. Further research examining the possible reasons for this increased risk is needed to improve patient outcomes and reduce healthcare costs. Additionally, future research should explore these risks within the hypertensive geriatric cohort for other orthopaedic procedures as well. It is important for orthopaedic surgeons to be aware of these risks to assist in decision making for surgical management and so that they can better educate their patients of these risks. However, even with this risk, an octogenarian age should not be used independently in evaluating if a hypertensive geriatric patient is a safe rTKA candidate.
Funding
No funds, grants, or other support was received.
Availability of data and material
Not applicable
Code availability
Not applicable.
Financial interests
The authors declare they have no financial interests.
Ethics approval
Institutional review board approval was not required for this study as all data is de-identified and public.
No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.
Declaration of competing interest
The authors have no conflicts of interest to declare that are relevant to the content of this article.
References
- 1.Mills K.T., Stefanescu A., He J. The global epidemiology of hypertension. Nat Rev Nephrol. 2020;16:223–237. doi: 10.1038/s41581-019-0244-2. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Wang W., Lee E.T., Fabsitz R.R., et al. A longitudinal study of hypertension risk factors and their relation to cardiovascular disease: the Strong Heart Study. Hypertension. 2006;47:403–409. doi: 10.1161/01.HYP.0000200710.29498.80. [DOI] [PubMed] [Google Scholar]
- 3.Cushman W.C. The burden of uncontrolled hypertension: morbidity and mortality associated with disease progression. J Clin Hypertens (Greenwich) 2003;5:14–22. doi: 10.1111/j.1524-6175.2003.02464.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Aronow W.S. Management of hypertension in patients undergoing surgery. Ann Transl Med. 2017;5:227. doi: 10.21037/atm.2017.03.54. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Walters C.L., Schneider K.E., Whitworth J.M., et al. Perioperative morbidity and mortality in octogenarians with ovarian cancer. Int J Gynecol Cancer. 2013;23:1006–1009. doi: 10.1097/IGC.0b013e3182980fac. [DOI] [PubMed] [Google Scholar]
- 6.Trickey A.W., Wright J.M., Donovan J., et al. Interrater reliability of hospital readmission evaluations for surgical patients. Am J Med Qual. 2017;32:201–207. doi: 10.1177/1062860615623854. [DOI] [PubMed] [Google Scholar]
- 7.Tornero E., García-Oltra E., García-Ramiro S., et al. Prosthetic joint infections due to Staphylococcus aureus and coagulase-negative staphylococci. Int J Artif Organs. 2012;35:884–892. doi: 10.5301/ijao.5000148. [DOI] [PubMed] [Google Scholar]
- 8.Schurr P., Boeken U., Litmathe J., Feindt P., Kurt M., Gams E. Predictors of postoperative complications in octogenarians undergoing cardiac surgery. Thorac Cardiovasc Surg. 2010;58:200–203. doi: 10.1055/s-0029-1240654. [DOI] [PubMed] [Google Scholar]
- 9.Pelavski A.D., De Miguel M., Alcaraz Garcia-Tejedor G., et al. Mortality, geriatric, and nongeriatric surgical risk factors among the eldest old: a prospective observational study. Anesth Analg. 2017;125:1329–1336. doi: 10.1213/ANE.0000000000002389. [DOI] [PubMed] [Google Scholar]
- 10.McKissack H.M., Viner G.C., Jha A.J., et al. Comparison of risk factors for postoperative complications across age groups in patients undergoing ORIF of the ankle. Injury. 2019;50:2116–2122. doi: 10.1016/j.injury.2019.09.014. [DOI] [PubMed] [Google Scholar]
- 11.Kocher N.J., Canes D., Bensalah K., et al. Incidence and preoperative predictors for major complications following radical nephroureterectomy. Transl Androl Urol. 2020;9:1786–1793. doi: 10.21037/tau.2020.01.22. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 12.Barnett S.D., Halpin L.S., Speir A.M. Incidence of postoperative complications among coronary artery bypass patients with and without hypertension. Outcome Manag. 2003;7:33–38. [PubMed] [Google Scholar]
- 13.Aronson S., Boisvert D., Lapp W. Isolated systolic hypertension is associated with adverse outcomes from coronary artery bypass grafting surgery. Anesth Analg. 2002;94:1079–1084. doi: 10.1097/00000539-200205000-00005. [DOI] [PubMed] [Google Scholar]
- 14.Belmont P.J., Jr., Goodman G.P., Kusnezov N.A., et al. Postoperative myocardial infarction and cardiac arrest following primary total knee and hip arthroplasty: rates, risk factors, and time of occurrence. J Bone Joint Surg Am. 2014;96:2025–2031. doi: 10.2106/JBJS.N.00153. [DOI] [PubMed] [Google Scholar]
- 15.Ahmed A.A., Mooar P.A., Kleiner M., Torg J.S., Miyamoto C.T. Hypertensive patients show delayed wound healing following total hip arthroplasty. PLoS One. 2011;6 doi: 10.1371/journal.pone.0023224. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 16.Schick C.W., Koehler D.M., Martin C.T., et al. Risk factors for 30-day postoperative complications and mortality following open reduction internal fixation of distal radius fractures. J Hand Surg Am. 2014;39:2373–2380.e1. doi: 10.1016/j.jhsa.2014.09.017. [DOI] [PubMed] [Google Scholar]
- 17.Greenky M.R., Wang W., Ponzio D.Y., Courtney P.M. Total hip arthroplasty and the Medicare inpatient-only list: an analysis of complications in medicare-aged patients undergoing outpatient surgery. J Arthroplasty. 2019;34:1250–1254. doi: 10.1016/j.arth.2019.02.031. [DOI] [PubMed] [Google Scholar]
- 18.Dy C.J., Wilkinson J.D., Tamariz L., Scully S.P. Influence of preoperative cardiovascular risk factor clusters on complications of total joint arthroplasty. Am J Orthop (Belle Mead NJ) 2011;40:560–565. [PubMed] [Google Scholar]
- 19.von Glinski A., Elia C., Ansari D., et al. Complications and mortality in octogenarians undergoing lumbopelvic fixation. World Neurosurg. 2020;134:e272–e276. doi: 10.1016/j.wneu.2019.10.040. [DOI] [PubMed] [Google Scholar]
- 20.Scott B.H., Seifert F.C., Grimson R., Glass P.S. Octogenarians undergoing coronary artery bypass graft surgery: resource utilization, postoperative mortality, and morbidity. J Cardiothorac Vasc Anesth. 2005;19:583–588. doi: 10.1053/j.jvca.2005.03.030. [DOI] [PubMed] [Google Scholar]
- 21.Hamel M.B., Henderson W.G., Khuri S.F., Daley J. Surgical outcomes for patients aged 80 and older: morbidity and mortality from major noncardiac surgery. J Am Geriatr Soc. 2005;53:424–429. doi: 10.1111/j.1532-5415.2005.53159.x. [DOI] [PubMed] [Google Scholar]
- 22.Halachmi S., Katz Y., Meretyk S., Barak M. Perioperative morbidity and mortality in 80 years and older undergoing elective urology surgery - a prospective study. Aging Male. 2008;11:162–166. doi: 10.1080/13685530802351081. [DOI] [PubMed] [Google Scholar]
- 23.Mahdi H., Wiechert A., Lockhart D., Rose P.G. Impact of age on 30-day mortality and morbidity in patients undergoing surgery for ovarian cancer. Int J Gynecol Cancer. 2015;25:1216–1223. doi: 10.1097/IGC.0000000000000486. [DOI] [PubMed] [Google Scholar]
- 24.Gray M.T., Hidden K.A., Malik A.T., et al. Octogenarian and nonagenarians are at a higher risk for experiencing adverse 30-day outcomes following ORIF of ankle fractures. Geriatr Orthop Surg Rehabil. 2021;12 doi: 10.1177/21514593211011462. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 25.Bovonratwet P., Malpani R., Ottesen T.D., et al. Aseptic revision total hip arthroplasty in the elderly : quantifying the risks for patients over 80 years old. Bone Joint J. 2018;100-B:143–151. doi: 10.1302/0301-620X.100B2.BJJ-2017-0895.R1. [DOI] [PubMed] [Google Scholar]
- 26.Bohl D.D., Ondeck N.T., Darrith B., Hannon C.P., Fillingham Y.A., Della Valle C.J. Impact of operative time on adverse events following primary total joint arthroplasty. J Arthroplasty. 2018;33:2256–2262.e4. doi: 10.1016/j.arth.2018.02.037. [DOI] [PubMed] [Google Scholar]
- 27.Surace P., Sultan A.A., George J., et al. The association between operative time and short-term complications in total hip arthroplasty: an analysis of 89,802 surgeries. J Arthroplasty. 2019;34:426–432. doi: 10.1016/j.arth.2018.11.015. [DOI] [PubMed] [Google Scholar]
- 28.National Surgical Quality improvement Program. Am Coll Surg. Accessed May 17, 2021. www.acsnsqip.org.
- 29.Wilson J.M., Farley K.X., Erens G.A., Guild G.N., 3rd General vs spinal anesthesia for revision total knee arthroplasty: do complication rates differ? J Arthroplasty. 2019;34:1417–1422. doi: 10.1016/j.arth.2019.03.048. [DOI] [PubMed] [Google Scholar]
- 30.Wilson J.M., Farley K.X., Erens G.A., Bradbury T.L., Guild G.N. Preoperative depression is associated with increased risk following revision total joint arthroplasty. J Arthroplasty. 2020;35:1048–1053. doi: 10.1016/j.arth.2019.11.025. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 31.Tihista M., Gu A., Wei C., Weinreb J.H., Rao R.D. The impact of long-term corticosteroid use on acute postoperative complications following lumbar decompression surgery. J Clin Orthop Trauma. 2020;11:921–927. doi: 10.1016/j.jcot.2020.04.010. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 32.Chen A.Z., Gu A., Selemon N.A., et al. Preoperative estimated glomerular filtration rate is a marker for postoperative complications following aseptic revision total hip arthroplasty. Eur J Orthop Surg Traumatol. 2021;31:175–182. doi: 10.1007/s00590-020-02761-9. [DOI] [PubMed] [Google Scholar]
- 33.Zhang W., Chen E., Xue D., Yin H., Pan Z. Risk factors for wound complications of closed calcaneal fractures after surgery: a systematic review and meta-analysis. Scand J Trauma Resuscitation Emerg Med. 2015;23:18. doi: 10.1186/s13049-015-0092-4. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 34.Gaston M.S., Amin A.K., Clayton R.A., Brenkel I.J. Does a history of cardiac disease or hypertension increase mortality following primary elective total hip arthroplasty? Surgeon. 2007;5:260–265. doi: 10.1016/s1479-666x(07)80021-7. [DOI] [PubMed] [Google Scholar]
- 35.Belmont P.J., Jr., Goodman G.P., Waterman B.R., Bader J.O., Schoenfeld A.J. Thirty-day postoperative complications and mortality following total knee arthroplasty: incidence and risk factors among a national sample of 15,321 patients. J Bone Joint Surg Am. 2014;96:20–26. doi: 10.2106/JBJS.M.00018. [DOI] [PubMed] [Google Scholar]
- 36.Widmer R.J., Lerman A. Endothelial dysfunction and cardiovascular disease. Glob Cardiol Sci Pract. 2014;2014:291–308. doi: 10.5339/gcsp.2014.43. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 37.Hwang S.H., Park D.J., Jee Y.S., et al. Risk factors for operative complications in elderly patients during laparoscopy-assisted gastrectomy. J Am Coll Surg. 2009;208:186–192. doi: 10.1016/j.jamcollsurg.2008.10.023. [DOI] [PubMed] [Google Scholar]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
Not applicable