Development and internal validation of a complexity scoring system for elbow arthroplasty: The Elbow Arthroplasty Severity (EASe) score

Abstract

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.