Most deaths occur after 2 weeks postop among total elbow arthroplasty patients

Patients with an underlying diagnosis of distal humeral fracture or distal humeral nonunion had a significantly higher risk of death.

While total elbow arthroplasty is associated with a low mortality incidence, of those deaths associated with the procedure most occur at least 2 weeks after surgery, according to a study by Mayo Clinic researchers.

"This finding is in contrast to the experience reported after hip and knee arthroplasties, in which a large number of patients died within the first 24 hours after surgery, and similar to the experience reported after shoulder arthroplasty," the study authors wrote.

"Thus, mortality after upper-extremity arthroplasty seems to have a different pattern than mortality after lower-extremity arthroplasty," they wrote.

Joaquin Sanchez-Sotelo, MD, PhD, and colleagues reviewed records for 1,441 total elbow arthroplasty procedures performed in 1,117 patients from 1970 to 2002. The researchers sought to identify perioperative risk factors for mortality associated with the procedure.

Overall, nine patients had died within 90 days after surgery, yielding a 0.62% overall 90-day mortality rate.

These nine patients averaged 66 years of age at surgery compared with a mean age of 58 years for the 1,117 patients overall. Also, seven of the nine patients who died were women. However, neither age nor gender were identified as significant risk factors for mortality, according to the study, published in the American edition of the Journal of Bone and Joint Surgery.

Seven deaths occurred among 1,076 primary total elbow arthroplasties, for an overall prevalence rate of 0.65% for such cases. The other two deaths occurred among 365 revision procedures, for an overall prevalence rate of 0.55% for these cases, according to the study.

"The risk of 90-day mortality was slightly higher after primary total elbow arthroplasty, but the difference did not reach significance," the authors wrote.

However, the preoperative diagnosis was closely associated with the risk for postoperative mortality, the authors noted.

Specifically, patients who had an underlying diagnosis of distal humeral fracture, including pathologic fracture, or of distal humeral nonunion had a significantly higher risk of death. Of the nine deaths, three patients had traumatic distal humeral fractures, one had a pathologic distal humeral fracture and two had distal humeral nonunion, according to the study.

Six of the nine patients who died had also undergone previous surgery, the authors added.

The deaths occurred an average of 45 days after surgery, ranging from 1 day to 88 days. The duration of postoperative hospitalization averaged 5 days and, excluding the one patients who died on the first day postop, ranged from 2 to 14 days.

"All patients who died had had substantial associated comorbidities, which played a major role in the outcome and independently increased the risk of death," the study authors wrote, noting that most patients die due to cardiopulmonary events.

Three patients died from congestive heart failure, and one patient each died from the following: myocardial infarction, acute heart embolus, respiratory failure, pneumonia, renal failure and bleeding secondary to a gastric stress ulcer, according to the study.

For more information:
Sanchez-Sotelo J, Sperling JW, Morrey BF. Ninety-day mortality after total elbow arthroplasty. J Bone Joint Surg Am. 2007;89-A:1449-1451.