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Development and internal validation of a complexity scoring system for elbow arthroplasty: The Elbow Arthroplasty
Matthew Howard1, William Thomas1, Chris Smith1
1Department of Trauma & Orthopaedic Surgery, Royal Devon & Exeter Hospital, Exeter, UK.
Background:
Elbow arthroplasty is associated with high complication rates and increasing centralisation of care. The Elbow Arthroplasty Severity (EASe) score was developed to stratify risk and predict complications.
Methods:
Initial EASe (version 1) score comprised six components reflecting procedural complexity, local pathology, and frailty (0-6). Scores were retrospectively applied to a cohort of patients undergoing primary or revision elbow arthroplasty. The primary outcome was any postoperative complication; secondary outcomes included major complications, unplanned re-operation, 30-day readmission, mortality <1 year, and length of stay. Based on observed associations and clinical plausibility, a re-weighted EASe (version 2) score (0-8) was constructed.
Results:
110 procedures were included, with an overall complication rate of 41.8% and a major complication rate of 21.8%. EASe(v1) score showed limited discrimination for any complication but acceptable discrimination for major complications (AUC ≈ 0.70). Soft tissue compromise and infection were independently associated with adverse outcomes. EASe(v2) score demonstrated improved prognostic performance, with fair discrimination for any complication (AUC ≈ 0.66) and good discrimination for major complications (AUC ≈ 0.78). Using Youden's index, the EASe(v2) score ≥4 provided the most accurate threshold for predicting major complications.
Conclusion:
EASe scoring helps stratify complexity and risk in elbow arthroplasty, supporting surgical planning and informed consent. Prospective multicentre validation is required.
