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The Update on Instruments Used for Evaluation of Comorbidities in Total Hip Arthroplasty
Łukasz Pulik1, Michał Podgajny2, Wiktor Kaczyński2
1Department of Orthopedics and Traumatology, Medical University of Warsaw, Lindley 4 St, 02-005 Warsaw, Poland.
Insights
Assessing patient comorbidity is crucial for total hip arthroplasty (THA) outcomes. This systematic review identifies and evaluates various comorbidity indices used in THA research, highlighting their heterogeneity.
Area of Science:
- Orthopedic Surgery
- Medical Informatics
- Health Services Research
Background:
- Concomitant diseases significantly impact total hip arthroplasty (THA) outcomes.
- Preoperative assessment of comorbidity burden is essential for routine screening due to THA's complication risk.
- Multimorbidity is measured using dedicated clinical tools.
Purpose of the Study:
- To systematically review instruments used for evaluating comorbidities in total hip arthroplasty (THA) studies.
- To identify indices with proven impact on THA revision risk, adverse events, mortality, or physical functioning.
- To provide a comprehensive list of suitable indices for THA outcomes research.
Main Methods:
- Systematic review of medical databases (PubMed, Web of Science, Embase).
- Two independent researchers searched for instruments assessing patient comorbidities.
- Inclusion criteria focused on indices impacting key THA outcomes.
Main Results:
- 26 articles were included from an initial search of 564.
- Commonly used tools included Charlson Comorbidity Index (18/26), Society of Anesthesiology classification (10/26), Elixhauser Comorbidity Method (6/26), and modified Frailty Index (5/26).
- Eleven indices were identified as suitable for THA outcomes studies, measuring outcomes like quality of life, complications, and mortality.
Conclusions:
- Comorbidity assessment tools in THA studies exhibit high heterogeneity.
- No single comorbidity assessment system is uniformly adopted in THA research.
- This review serves as a guide for researchers selecting appropriate comorbidity indices for THA studies.
Introduction:
It is a well-established fact that concomitant diseases can affect the outcome of total hip arthroplasty (THA). Therefore, careful preoperative assessment of a patient's comorbidity burden is a necessity, and it should be a part of routine screening as THA is associated with a significant number of complications. To measure the multimorbidity, dedicated clinical tools are used.
Methods:
The article is a systematic review of instruments used to evaluate comorbidities in THA studies. To create a list of available instruments for assessing patient's comorbidities, the search of medical databases (PubMed, Web of Science, Embase) for indices with proven impact on revision risk, adverse events, mortality, or patient's physical functioning was performed by two independent researchers.
Results:
The initial search led to identifying 564 articles from which 26 were included in this review. The measurement tools used were: The Charlson Comorbidity Index (18/26), Society of Anesthesiology classification (10/26), Elixhauser Comorbidity Method (6/26), and modified Frailty Index (5/26). The following outcomes were measured: quality of life and physical function (8/26), complications (10/26), mortality (8/26), length of stay (6/26), readmission (5/26), reoperation (2/26), satisfaction (2/26), blood transfusion (2/26), surgery delay or cancelation (1/26), cost of care (1/26), risk of falls (1/26), and use of painkillers (1/26). Further research resulted in a comprehensive list of eleven indices suitable for use in THA outcomes studies.
Conclusion:
The comorbidity assessment tools used in THA studies present a high heterogeneity level, and there is no particular system that has been uniformly adopted. This review can serve as a help and an essential guide for researchers in the field.
