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Ranking the Orthopedic Procedures With the Highest Morbidity and Mortality
Insights
Orthopedic surgery risks vary significantly, with above-knee amputations having the highest mortality and femoral shaft fracture repair showing the most adverse events. Lower extremity procedures and those in older adults carry increased risks.
Area of Science:
- Orthopedic Surgery
- Patient Safety
- Risk Stratification
Background:
- Musculoskeletal conditions impact over a third of the US population, making orthopedic procedures crucial for management.
- Invasive orthopedic interventions carry inherent risks, necessitating clear understanding of associated morbidity and mortality.
- A global perspective on orthopedic procedure risks is needed to develop effective risk stratification tools.
Purpose of the Study:
- To provide a global overview of risks and complications associated with orthopedic procedures.
- To establish an accessible risk stratification tool for patients and healthcare providers.
- To analyze morbidity and mortality rates across various orthopedic surgical procedures.
Main Methods:
- Utilized Current Procedural Terminology (CPT) codes for orthopedic surgeries from the 2018-2020 American College of Surgeons National Surgical Quality Improvement Program database.
- Assessed 30-day mortality rates and rates of any adverse event (AAE) for each identified CPT code.
- Ranked CPT codes based on morbidity and AAE rates for descriptive analysis.
Main Results:
- Analyzed 698,549 patients across 94 CPT codes with morbidity and 144 CPT codes with AAE.
- Above-knee amputation (CPT code 27590) demonstrated the highest mortality rate.
- Open treatment of femoral shaft fracture with plate and screws (CPT code 27507) exhibited the highest rate of AAE.
Conclusions:
- This study is the first to compare morbidity and mortality rates across all orthopedic procedures.
- A notable bias indicates increased risk associated with lower extremity surgeries.
- Orthopedic procedures frequently performed in the geriatric population showed a higher risk profile.
Background:
Musculoskeletal conditions currently affect more than one-third of the US population and orthopedic procedures play a pivotal role in managing them. Like any invasive intervention, these carry a wide spectrum of risk, necessitating a comprehensive understanding of the associated morbidity and mortality. This study sought to provide a global perspective of the risks and complications associated with these procedures to establish an easy to understand risk stratification tool for both patients and providers.
Materials And Methods:
Current Procedural Terminology codes associated with orthopedic surgery were identified in the American College of Surgeons National Surgical Quality Improvement Program database from 2018 to 2020. Each code was associated with its rate of 30-day mortality as well as any adverse event (AAE) and then ranked for descriptive analysis.
Results:
In total, there were 698,549 patients who underwent orthopedic procedures associated with 94 CPT codes with at least 1 morbidity event and 144 CPT codes with at least 1 AAE. The CPT code associated with the highest mortality was 27590 or above knee amputation. The CPT code associated with the highest rate of AAE was 27507 or open treatment of femoral shaft fracture with plate and screws.
Conclusion:
This is the first study to compare the rates of morbidity and mortality in all patients with orthopedic procedures. There was a strong bias toward increased risk associated with lower extremity surgery and surgery most often performed in the geriatric population. [Orthopedics. 2025;48(1):e40-e44.].
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