{
  "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.",
  "authors": [
    {
      "affiliations": [
        "Department of Anaesthesia, Austin Health, Heidelberg, Victoria, Australia"
      ],
      "name": "Je Min Suh"
    },
    {
      "affiliations": [
        "Department of Anesthesiology and Pain Medicine, Dongguk University Ilsan Hospital, Goyang-si, Korea (the Republic of)"
      ],
      "name": "Dong-Kyu Lee"
    },
    {
      "affiliations": [
        "Department of Anaesthesia, Austin Health, Heidelberg, Victoria, Australia"
      ],
      "name": "Angelina Yoon"
    },
    {
      "affiliations": [
        "Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand"
      ],
      "name": "Nattaya Raykateeraroj"
    },
    {
      "affiliations": [
        "Department of Orthopaedic Surgery, Austin Health, Heidelberg, Victoria, Australia"
      ],
      "name": "Andrew Hardidge"
    },
    {
      "affiliations": [
        "Department of Anaesthesia, Austin Health, Heidelberg, Victoria, Australia"
      ],
      "name": "Sophia Grobler"
    },
    {
      "affiliations": [
        "Department of Anaesthesia, Austin Health, Heidelberg, Victoria, Australia"
      ],
      "name": "Grace Kwon"
    },
    {
      "affiliations": [
        "Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia",
        "Department of Intensive Care, The Alfred Hospital, Melbourne, Victoria, Australia"
      ],
      "name": "David Pilcher"
    },
    {
      "affiliations": [
        "Department of Anaesthesia, Austin Health, Heidelberg, Victoria, Australia",
        "Department of Critical Care, The University of Melbourne, Melbourne, Victoria, Australia"
      ],
      "name": "Laurence Weinberg"
    }
  ],
  "title": "Surgical urgency and outcomes in nonagenarian and centenarian patients admitted to the ICU after hip replacement: a binational multicenter cohort study",
  "uid": "d8cddd7a-0fc5-572a-a76a-cb8292a993e0"
}