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The Utility of Comorbidity Indices in Assessing Head and Neck Surgery Outcomes: A Systematic Review
Kavya Pai1, Carla Baaklini2, Claudia I Cabrera3,4
1University of Toledo College of Medicine and Life Sciences, Toledo, Ohio, U.S.A.
Insights
Comorbidity index scores offer valuable insights into head and neck surgery outcomes. The Charlson Comorbidity Index (CCI) and Adult Comorbidity Evaluation-27 (ACE-27) show promise in predicting mortality.
Area of Science:
- Medical research
- Surgical outcomes
- Health informatics
Background:
- Comorbidity index (CI) scores are increasingly utilized to predict patient outcomes.
- Head and neck surgery (HNS) involves complex procedures where patient comorbidities significantly impact results.
- Evaluating the predictive utility of various CIs in HNS is crucial for optimizing patient care.
Purpose of the Study:
- To systematically review and evaluate the utility of different comorbidity index scores in predicting outcomes within head and neck surgery.
- To compare the performance of seven distinct CIs: Charlson Comorbidity Index (CCI), Elixhauser Comorbidity Index (ECI), Kaplan-Feinstein Index (KFI), American Society of Anesthesiologists Physical Status (ASA-PS), Adult Comorbidity Evaluation-27 (ACE-27), National Cancer Institute Comorbidity Index (NCI-CI), and Washington University Head and Neck Comorbidity Index (WUHNCI).
Main Methods:
- A systematic review was conducted following the 2009 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
- Literature searches were performed across PubMed, Cochrane, and Embase databases, supplemented by manual bibliography searches.
- Studies associating CI scores with HNS outcomes were identified and analyzed.
Main Results:
- A total of 116 studies were included, with ASA-PS (70/116) and CCI (39/116) being the most frequently reported CIs.
- The Charlson Comorbidity Index (CCI) and Adult Comorbidity Evaluation-27 (ACE-27) demonstrated predictive value for mortality in head and neck surgery.
- The Elixhauser Comorbidity Index (ECI) showed consistency in predicting mortality beyond one year, while ACE-27 and Kaplan-Feinstein Index (KFI) were most consistent for medical complications.
Conclusions:
- Comorbidity index scores provide valuable insights into the impact of comorbidities on head and neck surgery outcomes, despite existing literature inconsistencies.
- These scores should be integrated as an adjunct tool in the preoperative assessment of patients undergoing head and neck surgery.
- Further comparative studies are necessary to determine the most reliable CI for predicting specific HNS outcomes.
Objective:
To evaluate the utility of comorbidity index (CI) scores in predicting outcomes in head and neck surgery (HNS). The CIs evaluated were the Charlson Comorbidity Index (CCI), Elixhauser Comorbidity Index (ECI), Kaplan-Feinstein Index (KFI), American Society of Anesthesiologists Physical Status (ASA-PS), Adult Comorbidity Evaluation-27 (ACE-27), National Cancer Institute Comorbidity Index (NCI-CI), and the Washington University Head and Neck Comorbidity Index (WUHNCI).
Methods:
We report a systematic review according to the 2009 Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Electronic databases (PubMed, Cochrane, and Embase) and manual search of bibliographies identified manuscripts addressing how CI scores related to HNS outcomes.
Results:
A total of 116 studies associated CI scores with HNS outcomes. CIs were represented in the literature as follows: ASA-PS (70/116), CCI (39/116), ACE-27 (24/116), KFI (7/116), NCI-CI (3/116), ECI (2/116), and WUHNCI (1/116). The most frequently cited justification for calculating each CI (if provided) was: CCI for its validation in other studies, ACE-27 for its utility in cancer patients, and ECI for its comprehensive design. In general, the CCI and ACE-27 were predictive of mortality in HNS. The ECI was most consistent in predicting >1-year mortality. The ACE-27 and KFI were most consistent in predicting medical complications.
Conclusion:
Despite inconsistencies in the literature, CIs provide insights into the impact of comorbidities on outcomes in HNS. These scores should be employed as an adjunct in the preoperative assessment of HNS patients. Comparative studies are needed to identify indices that are most reliable in predicting HNS outcomes.
Level Of Evidence:
NA Laryngoscope, 132:1388-1402, 2022.
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