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ASA grade and Charlson Comorbidity Index of spinal surgery patients: correlation with complications and societal
Robert G Whitmore1, James H Stephen1, Coleen Vernick2
1Department of Neurosurgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA.
Insights
The Charlson Comorbidity Index (CCI) and American Society of Anesthesiologists (ASA) grade predict complications after spine surgery. Developing a spine-specific index could improve patient counseling and treatment decisions.
Area of Science:
- Orthopedic Surgery
- Anesthesiology
- Health Economics
Background:
- The Charlson Comorbidity Index (CCI) and American Society of Anesthesiologists (ASA) Physical Status Classification System (ASA grade) are established tools for predicting patient outcomes.
- Their utility in the context of spine surgery, specifically regarding complication prediction and healthcare costs, warrants further investigation.
Purpose of the Study:
- To evaluate the Charlson Comorbidity Index (CCI) and ASA grade as predictors of complications following spinal surgery.
- To examine the correlation between these comorbidity indices and the direct healthcare costs associated with spine surgery.
Main Methods:
- A prospective observational study was conducted involving patients undergoing any type of spine surgery at a single academic tertiary center over six months.
- Data collected included patient demographics, comorbidities, procedural details, and complications within 30 days. CCI was calculated from ICD-9-CM codes, and ASA grades were determined from operative records.
- Direct healthcare costs were estimated using diagnosis-related group and Current Procedural Terminology (CPT) codes, based on Medicare reimbursement rates. Multivariable analysis assessed the association of CCI and ASA grade with complication rates and costs.
Main Results:
- The study analyzed 226 cases, with an average CCI of 0.92 and an average ASA grade of 2.65.
- Both CCI and ASA grade showed significant correlations with increasing patient age and body mass index.
- Increasing CCI was associated with a higher likelihood of any complication and minor complications. Increasing ASA grade was linked to a greater likelihood of major complications and higher direct healthcare costs.
Conclusions:
- The CCI and ASA grade are valuable comorbidity indices for patients undergoing spine surgery but do not fully predict complication occurrence.
- A dedicated spine-specific comorbidity index, easily derivable from ICD-9-CM codes, could enhance patient counseling and guide surgical intervention choices.
Background Context:
The Charlson Comorbidity Index (CCI) and the American Society of Anesthesiologists (ASA) Physical Status Classification System (ASA grade) are useful for predicting morbidity and mortality for a variety of disease processes.
Purpose:
To evaluate CCI and ASA grade as predictors of complications after spinal surgery and examine the correlation between these comorbidity indices and the cost of care.
Study Design/Setting:
Prospective observational study.
Patient Sample:
All patients undergoing any spine surgery at a single academic tertiary center over a 6-month period.
Outcome Measures:
Direct health-care costs estimated from diagnosis related group and Current Procedural Terminology (CPT) codes.
Methods:
Demographic data, including all patient comorbidities, procedural data, and all complications, occurring within 30 days of the index procedure were prospectively recorded. Charlson Comorbidity Index was calculated from International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes and ASA grades determined from the operative record. Diagnosis related group and CPT codes were captured for each patient. Direct costs were estimated from a societal perspective using Medicare rates of reimbursement. A multivariable analysis was performed to assess the association of the CCI and ASA grade to the rate of complication and direct health-care costs.
Results:
Two hundred twenty-six cases were analyzed. The average CCI score for the patient cohort was 0.92, and the average ASA grade was 2.65. The CCI and ASA grade were significantly correlated, with Spearman ρ of 0.458 (p<.001). Both CCI and ASA grade were associated with increasing body mass index (p<.01) and increasing patient age (p<.0001). Increasing CCI was associated with an increasing likelihood of occurrence of any complication (p=.0093) and of minor complications (p=.0032). Increasing ASA grade was significantly associated with an increasing likelihood of occurrence of a major complication (p=.0035). Increasing ASA grade showed a significant association with increasing direct costs (p=.0062).
Conclusions:
American Society of Anesthesiologists and CCI scores are useful comorbidity indices for the spine patient population, although neither was completely predictive of complication occurrence. A spine-specific comorbidity index, based on ICD-9-CM coding that could be easily captured from patient records, and which is predictive of patient likelihood of complications and mortality, would be beneficial in patient counseling and choice of operative intervention.
