Higher Charlson Comorbidity Index Scores are associated with readmission after orthopaedic surgery
Timothy Voskuijl1, Michiel Hageman, David Ring
1Department of Orthopaedic Surgery, Massachusetts General Hospital, Yawkey Center, Suite 2100, 55 Fruit Street, Boston, MA, 02114, USA.
Insights
The Charlson Comorbidity Index (CCI) predicts readmission risk after orthopaedic surgery. Higher CCI scores correlate with increased readmission, transfusion, and mortality risks, but not surgical site infections.
Area of Science:
- Orthopaedic Surgery
- Medical Comorbidity Assessment
- Patient Outcomes Research
Background:
- The Charlson Comorbidity Index (CCI) was initially developed to predict 1-year mortality in non-trauma patients.
- Its utility in predicting outcomes after orthopaedic surgery, such as readmission, has not been previously investigated.
Purpose of the Study:
- To determine if an elevated CCI score is associated with readmission after orthopaedic surgery.
- To assess the relationship between CCI score and the risk of surgical site infection, adverse events, transfusion, and mortality post-orthopaedic surgery.
Main Methods:
- Analysis of 30,129 orthopaedic surgeries between 2008-2011.
- Utilized International Classification of Diseases, 9th Revision codes to identify diagnoses, procedures, and outcomes.
- Employed ordinary least squares regression to evaluate CCI associations with readmission, adverse events, surgical site infection, transfusion, and mortality.
Main Results:
- The CCI explained 10% of the variation in readmissions, with increased risk per CCI point for arthroplasty, trauma, and spine surgeries.
- A significant association was found between CCI score and transfusion rates (8% variation) and 30-day mortality (10% variation).
- No significant association was observed between CCI score and surgical site infections or other adverse events.
Conclusions:
- The CCI serves as a valuable tool for estimating readmission risk across various orthopaedic subspecialties including arthroplasty, hand/upper extremity, spine, and trauma surgery.
- The CCI can also predict transfusion risk in arthroplasty, spine, trauma, and oncologic orthopaedic surgery.
- The CCI is useful for estimating mortality risk after shoulder, trauma, and oncologic orthopaedic procedures.
Background:
The Charlson Comorbidity Index (CCI) originally was developed to predict mortality within 1 year of hospital admission in patients without trauma. As it includes factors associated with medical and surgical complexities, it also may be useful as a predictive tool for hospital readmission after orthopaedic surgery, but to our knowledge, this has not been studied.
Questions/Purposes:
We asked whether an increased score on the CCI was associated with (1) readmission, (2) an increased risk of surgical site infection or other adverse events, (3) transfusion risk, or (4) mortality after orthopaedic surgery.
Methods:
A total of 30,129 orthopaedic surgeries performed between 2008 and 2011 without any orthopaedic surgery in the preceding 30 days were analyzed. International Classification of Diseases, 9(th) Revision codes were used to identify diagnoses, procedures, surgery-related adverse events, surgical site infection, and comorbidities as listed in the updated and reweighted CCI. A total of 913 patients (3.0%) were readmitted within 30 days after discharge; in 393 (1.4%) patients adverse events occurred; 417 patients (1.4%) had a surgical site infection develop; 211 (0.7%) needed transfusions, and 56 (0.2%) died within 30 days after surgery. Ordinary least squares regression analyses were used to determine whether the CCI was associated with these outcomes.
Results:
The CCI accounted for 10% of the variation in readmissions. Every point increase in CCI score added an additional 0.45% risk in readmission for patients undergoing arthroplasty, 0.63% for patients undergoing trauma surgery, and 0.9% risk for patients undergoing spine surgery (all p < 0.01). The CCI was not associated with surgical site infection or other adverse events, but accounted for 8% of the variation in transfusion rate and 10% of the variation in mortality within 30 days of surgery.
Conclusions:
The CCI can be used to estimate the risk of readmission after arthroplasty, hand and upper extremity surgery, spine surgery, and trauma surgery. It also can be used to estimate the risk of transfusion after arthroplasty, spine, trauma, and oncologic orthopaedic surgery and the risk of mortality after shoulder, trauma, and oncologic orthopaedic surgery.
Level Of Evidence:
Level IV, prognostic study. See the Instructions for Authors for a complete description of levels of evidence.
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