Surgical urgency and outcomes in nonagenarian and centenarian patients admitted to the ICU after hip replacement: a binational multicenter cohort study
Issued Date
2026-05-01
Resource Type
eISSN
23975776
Scopus ID
2-s2.0-105037964045
Journal Title
Trauma Surgery and Acute Care Open
Volume
11
Issue
2
Rights Holder(s)
SCOPUS
Bibliographic Citation
Trauma Surgery and Acute Care Open Vol.11 No.2 (2026)
Suggested Citation
Suh J.M., Lee D.K., Yoon A., Raykateeraroj N., Hardidge A., Grobler S., Kwon G., Pilcher D., Weinberg L. Surgical urgency and outcomes in nonagenarian and centenarian patients admitted to the ICU after hip replacement: a binational multicenter cohort study. Trauma Surgery and Acute Care Open Vol.11 No.2 (2026). doi:10.1136/tsaco-2025-002194 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/116709
Title
Surgical urgency and outcomes in nonagenarian and centenarian patients admitted to the ICU after hip replacement: a binational multicenter cohort study
Corresponding Author(s)
Other Contributor(s)
Abstract
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 (<30 days, 30–365 days and >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.