Evaluation of critical postoperative situations in orthopedic patients

Most orthopedic surgery is elective. Even in the severely traumatized patient, orthopedic surgery is carried out after the patient's general condition stabilizes. Critical postoperative situations are still problems in orthopedic surgery. From November 1992 through May 1995, 7,325 patients were admitted to the orthopedic ward at the National Taiwan University Hospital and underwent surgery. We present a retrospective study of 78 postoperative orthopedic patients who were admitted to a surgical intensive care unit (ICU) during this period. Fourteen of these became vegetative or died. The patients admitted to an ICU were categorized into four groups, based on the type of surgery: arthroplasty (13 patients), spinal surgery (50), fracture other than spine (13), and others (2). The causes of ICU admission in each group were analyzed. The following operations were found to carry a high risk of postoperative complications: revisional total hip arthroplasty (one of four ICU-admitted patients died); debridement for infected total hip arthroplasty (two of two died); bilateral total knee arthroplasty (two of four died); and debridement of spinal infection (three of five died). The associated risk factors for ICU admission were: old age, underlying medical disease, pulmonary embolism in multiple fracture, respiratory compromise in spinal surgery, and massive blood loss. Great care should be taken when performing orthopedic surgery on patients with these risk factors.