Mortality among patients undergoing orthopedic surgeries and admitted to the ICU

Hussein Assaggaf, Fahad Ahmed Alrashed, Mansour Musaad Alsaluli, Hussain Saeed Alghamdi, Mohammed Saleh Alghamdi, Muteb Saad Alrabie, Abdulrahman Hassan Alasmari, Abdullah Naif Alsulaimani, Ahmed Essam Nasser, Nada Abdulqader Bukhari, Abdullah Abdulaziz Alzaidi


Many postoperative complications have been associated with orthopedic surgeries, which require patients to be admitted to intensive care units. In this study, we reviewed previous studies that reported the mortality rates for patients undergoing orthopedic surgeries and have been admitted to the ICU, in addition to discussing the risk factors and complications for this event and the possible preventive measures. Studies showed that mortality rates in the ICU following orthopedic procedures are much lower than other procedures that are usually associated with higher rates of complications and deaths. However, serious efforts should be offered to decrease the development of complications that may increase the burdens of such cases. To achieve this, the identification of the possible risk factors is essential for decreasing this burden. We found that old age, the presence of comorbidities, the complexity of the procedure, and having large amounts of blood transfusion before the procedure might be significant factors for the development of severe complications and subsequent death. We have also discussed some complications like cardiovascular, cerebral, spinal, pulmonary, and renal disorders. Eliminating these disorders would require more effort for eliminating pain, applying appropriate doses of anesthetics, antibiotics, and beta-blockers.


Mortality, Intensive care, Orthopedics

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Curran JE, Grounds RM. Ward versus intensive care management of high-risk surgical patients. Br J Surg. 1998;85(7):956-61.

Surya G, Ham. Orthopaedic patients who require intensive care admission. Trauma Treat. 2013;2:1-5.

Bhattacharyya T, Iorio R, Healy W. Rate of and Risk Factors for Acute Inpatient Mortality After Orthopaedic Surgery. J Bone Joint Surg Am. 2002; 84A:562-72.

Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of Primary and Revision Hip and Knee Arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am. 2007;89:780-5.

Aebi M, Mohler J, Zäch GA, Morscher E. Orthopedic operations: indications, technique and end results. J Am Med Assoc. 1940;114(24):2408.

Dandachli W, Cobb J. Complications in orthopaedic surgery. United Kingdom: Imperial College Press; 2007:689-725.

Mahomed N, Barrett J, Katz J, Baron J, Wright J, Losina E. Epidemiology of Total Knee Replacement in the United States Medicare Population. J Bone Joint Surg Am. 2005;87:1222-8.

Kreder HJ, Deyo RA, Koepsell T, Swiontkowski MF, Kreuter W. Relationship between the volume of total hip replacements performed by providers and the rates of postoperative complications in the state of Washington. J Bone Joint Surg Am. 1997;79(4): 485-94.

Bradford DS, Tay BK, Hu SS. Adult scoliosis: surgical indications, operative management, complications, and outcomes. Spine. 1999;24(24): 2617-29.

Courtney PM, Whitaker CM, Gutsche JT, Hume EL, Lee G-C. Predictors of the need for critical care after total joint arthroplasty: an update of our institutional risk stratification model. J Arthroplasty. 2014;29(7): 1350-4.

Miller R. Advances in Orthopedic Surgery. AORN J. 2018;108(1):9-11.

Ricketts D, Rogers RA, Roper T, Ge X. Recognising and dealing with complications in orthopaedic surgery. Ann R Coll Surg Engl. 2017;99(3):185-8.

Lee R, Lee D, Mamidi IS, Probasco WV, Heyer JH, Pandarinath R. Patients With Chronic Obstructive Pulmonary Disease Are at Higher Risk for Pneumonia, Septic Shock, and Blood Transfusions After Total Shoulder Arthroplasty. Clin Orthop Relat Res. 2019;477(2):416-23.

Klasan A, Dworschak P, Heyse TJ. COPD as a risk factor of the complications in lower limb arthroplasty: a patient-matched study. Int J Chron Obstruct Pulmon Dis. 2018;13:2495-9.

Friedman JM, Couso R, Kitchens M, et al. Benign heart murmurs as a predictor for complications following total joint arthroplasty. J Orthop. 2017; 14(4):470-4.

Courtney PM, Melnic CM, Gutsche J, Hume EL, Lee GC. Which patients need critical care intervention after total joint arthroplasty?. : a prospective study of factors associated with the need for intensive care following surgery. Bone Joint J. 2015;97-B(11): 1512-8.

Memtsoudis SG, Rosenberger P, Walz JM. Critical care issues in the patient after major joint replacement. J Intensive Care Med. 2007;22(2):92-104.

Gupta RM, Parvizi J, Hanssen AD, Gay PC. Postoperative complications in patients with obstructive sleep apnea syndrome undergoing hip or knee replacement: a case-control study. Mayo Clin Proc. 2001;76(9):897-905.

AbdelSalam H, Restrepo C, Tarity TD, Sangster W, Parvizi J. Predictors of intensive care unit admission after total joint arthroplasty. J Arthroplasty. 2012; 27(5):720-5.

Nahtomi-Shick O, Kostuik JP, Winters BD, Breder CD, Sieber AN, Sieber FE. Does intraoperative fluid management in spine surgery predict intensive care unit length of stay?. J Clin Anesth. 2001;13(3):208-12.

Weis JC, Betz RR, Clements DHI, Balsara RK. Prevalence of Perioperative Complications After Anterior Spinal Fusion for Patients with Idiopathic Scoliosis. Clin Spine Surg. 1997;10(5):371-5.

Raw DA, Beattie JK, Hunter JM. Anaesthesia for spinal surgery in adults. Br Journal Anaesth. 2003; 91(6):886-904.

Hagio K, Sugano N, Takashina M, Nishii T, Yoshikawa H, Ochi T. Embolic events during total hip arthroplasty: an echocardiographic study. J Arthroplasty. 2003;18(2):186-92.

Taylor JM, Gropper MA. Critical care challenges in orthopedic surgery patients. Crit Care Med. 2006; 34(9 Suppl):S191-9.

Kim Y-H, Oh SW, Kim JS. Prevalence of fat embolism following bilateral simultaneous and unilateral total hip arthroplasty performed with or without cement: A prospective, randomized clinical study. J Bone Joint Surg Am. 2002;84A:1372-9.

Nazon D, Abergel G, Hatem C. Critical care in orthopedic and spine surgery. Crit Care Clin. 2003; 19:33-53.

Fleisher LA. Preoperative Cardiac Evaluation before Noncardiac Surgery: Reverend Bayes’s Risk Indices and Optimal Variables. Anesthesiol. 2018;129(5): 867-8.

Malerba G, Romano-Girard F, Cravoisy A, Dousset B, Nace L, Lévy B, et al. Risk factors of relative adrenocortical deficiency in intensive care patients needing mechanical ventilation. Intensive Care Med. 2005;31(3):388-92.

Kress JP, Pohlman AS, O'Connor MF, Hall JB. Daily Interruption of Sedative Infusions in Critically Ill Patients Undergoing Mechanical Ventilation. N Engl J Med. 2000;342(20):1471-7.

Ekman EF, Koman LA. Acute pain following musculoskeletal injuries and orthopaedic surgery: mechanisms and management. Instr Course Lect. 2005;54:21-33.

Schweickert WD, Gehlbach BK, Pohlman AS, Hall JB, Kress JP. Daily interruption of sedative infusions and complications of critical illness in mechanically ventilated patients. Crit Care Med. 2004;32(6):1272-1276.

Wallace A, Mangano DT. Use of beta-blockade to prevent death after noncardiac surgery. West J Med. 1997;166(3):203-4.

Lindenauer PK, Fitzgerald J, Hoople N, Benjamin EM. The potential preventability of postoperative myocardial infarction: underuse of perioperative beta-adrenergic blockade. Arch Intern Med. 2004; 164(7):762-6.

Tornetta P, Mostafavi H, Riina J, Turen C, Reimer B, Levine R, et al. Morbidity and mortality in elderly trauma patients. J Trauma. 1999;46(4):702-6.

Memtsoudis SG, Sun X, Chiu Y-L. Utilization of critical care services among patients undergoing total hip and knee arthroplasty: epidemiology and risk factors. Anesthesiol. 2012;117(1):107-16.

Memtsoudis SG, Stundner O, Sun X, Chiu YL, Ma Y, Fleischut P, et al. Critical care in patients undergoing lumbar spine fusion: a population-based study. J Intensive Care Med. 2014;29(5):275-84.

Traven SA, McGurk KM, Reeves RA, Walton ZJ, Woolf SK, Slone HS. Modified frailty index predicts medical complications, length of stay, readmission, and mortality following total shoulder arthroplasty. J Shoulder Elbow Surg. 2019;28(10):1854-60.

Van den Berghe G, Wouters P, Weekers F, Verwaest C, Bruyninckx F, Schetz M, et al. Intensive insulin therapy in critically ill patients. N Engl J Med. 2001; 345(19):1359-67.

Silber JH, Rosenbaum PR, Trudeau ME. Preoperative antibiotics and mortality in the elderly. Ann Surg. 2005;242(1):107-114.

Saint S, Savel RH, Matthay MA. Enhancing the safety of critically ill patients by reducing urinary and central venous catheter-related infections. Am J Respir Crit Care Med. 2002;165(11):1475-9.