Orthopaedic surgeons operate on a diverse group of patients, and
many of these patients have concomitant medical problems. The purpose
of this study was to identify the rate of mortality and to evaluate
the risk factors associated with mortality after orthopaedic surgery.
Data from the National Hospital Discharge Survey, a nationwide
sample of hospital admissions, were obtained for the years 1995
through 1997. The study was limited to hospital admissions. Univariate
and multivariate analyses were performed.
The 43,215 inpatient orthopaedic operations that we evaluated were
associated with a mortality rate of 0.92%. Seventy-seven percent
of all deaths occurred after procedures performed for patients who
were more than seventy years old, and 50% of all deaths occurred
after operations performed for the treatment of hip fractures.
The independent preoperative medical risk factors for death included
chronic renal failure, congestive heart failure, metastasis to bone,
atrial fibrillation, chronic obstructive pulmonary disease, and
osteomyelitis. The risk factors of diabetes, coronary artery disease,
peripheral vascular disease, septic arthritis, and rheumatoid arthritis
did not achieve significance. Among orthopaedic subspecialty categories,
operations for tumors, trauma, and infection were associated with elevated
In a predictive model, five critical risk factors were identified as
most helpful in identifying patients at risk for death: chronic
renal failure, congestive heart failure, chronic obstructive pulmonary
disease, hip fracture, and an age of greater than seventy years.
The mortality rate was 0.25% for patients with no critical risk
factors. A linear increase in mortality was seen with increasing
numbers of critical risk factors (p < 0.005).
Death is rare after orthopaedic operations. In the United States,
the rate of acute mortality after inpatient orthopaedic surgical
procedures is approximately 1% for all patients, 3.1% for patients
with a hip fracture, and 0.5% for patients without a hip fracture.
These data will aid orthopaedic surgeons in predicting operative
mortality for their patients.