Ninety-Day Mortality After Total Elbow Arthroplasty

Background: Perioperative mortality, although seldom mentioned and rare after upper-extremity surgery, is one of the potential complications of total elbow arthroplasty. The purpose of this study was to determine the prevalence and risk factors associated with perioperative mortality after elbow arthroplasty.

Methods: The records of 1117 consecutive patients who had undergone 1441 total elbow arthroplasties at our institution between 1970 and 2002 were reviewed to identify patients who had died within ninety days after the procedure. A detailed analysis of the medical, surgical, anesthetic, and pathologic records of these patients was performed.

Results: The ninety-day mortality rate was 0.62% (nine of 1441 cases). Seven of the patients who died were female and two were male; their mean age at the time of surgery was sixty-six years. An underlying diagnosis of distal humeral fracture (including pathologic fracture) or nonunion was associated with an increased risk of death (p < 0.001). Seven patients died after primary arthroplasty and two, after revision arthroplasty. The average time from surgery to death was forty-five days. The causes of death were congestive heart failure (three patients) and myocardial infarction, acute heart embolus, respiratory failure, pneumonia, renal failure, and bleeding secondary to gastric stress ulcer (one patient each). All patients had substantial comorbidities.

Conclusions: The rate of perioperative mortality after total elbow arthroplasty is low. Most patients who die after this procedure are elderly, have substantial comorbidities, and underwent the total elbow arthroplasty for the treatment of a traumatic or pathologic distal humeral fracture or nonunion.

Level of Evidence: Prognostic Level II. See Instructions to Authors for a complete description of levels of evidence.