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Evaluation of comorbidity scoring systems in patients undergoing knee arthroplasty
Alexander Green1, Jonathan Old1, Oday Al-Dadah1,2
1Department of Trauma and Orthopaedic Surgery, South Tyneside District Hospital, South Tyneside, UK.
Insights
The Self-Administered Comorbidity Questionnaire (SACQ) shows some correlation with patient comorbidities in knee arthroplasty candidates. However, clinical assessments like the American Society of Anesthesiologists (ASA) grades and Charlson Comorbidity Index (CCI) offer stronger insights into perioperative risk.
Area of Science:
- Orthopedic Surgery
- Geriatric Medicine
- Health Outcomes Research
Background:
- Increasing demand for knee arthroplasty due to aging populations and rising comorbidity rates.
- Need for accurate patient comorbidity assessment for surgical risk stratification.
- Existing tools include patient-reported (Self-Administered Comorbidity Questionnaire) and clinician-evaluated (ASA, CCI) measures.
Purpose of the Study:
- To compare Self-Administered Comorbidity Questionnaire (SACQ) scores with American Society of Anesthesiologists (ASA) grades and Charlson Comorbidity Index (CCI) scores.
- To evaluate the association between SACQ scores and patient-reported knee outcome measures.
- To determine the utility of SACQ in assessing perioperative risk for knee arthroplasty.
Main Methods:
- Single-center observational cohort study.
- Inclusion of 141 patients undergoing elective knee arthroplasty for osteoarthritis.
- Preoperative data collection included SACQ, ASA grade, CCI, and validated knee outcome scores.
Main Results:
- SACQ scores showed a direct correlation with ASA grade (rho = 0.37, p < 0.001) and CCI scores (rho = 0.19, p = 0.047).
- Specific comorbidities like hypertension and COPD were associated with SACQ, while ASA and CCI were linked to a broader range of comorbidities.
- SACQ scores were inversely correlated with patient-reported outcome measures.
Conclusions:
- SACQ scores reflect increasing comorbidity in knee osteoarthritis patients undergoing arthroplasty.
- ASA grades and CCI demonstrate stronger associations with comorbidities and outcomes than SACQ.
- SACQ may supplement, but not replace, objective clinical assessments for perioperative risk evaluation in knee arthroplasty.
Background:
Ageing populations are increasing the demand for knee arthroplasty. Concurrently, the prevalence of medical comorbidities are rising too. The Self-Administered Comorbidity Questionnaire was developed to provide a patient's assessment of their own comorbidities whereas the American Society of Anesthesiologists grades and the Charlson Comorbidity Index utilise clinical evaluation to objectively measure perioperative morbidity and mortality risk. The primary aim of this study was to compare Self-Administered Comorbidity Questionnaire scores with American Society of Anesthesiologists grades and Charlson Comorbidity Index scores. The secondary aim was to compare Self-Administered Comorbidity Questionnaire scores with knee outcome scores.
Methods:
A single centre observational cohort study of patients with knee osteoarthritis undergoing elective knee arthroplasty. Preoperative evaluation included Self-Administered Comorbidity Questionnaire scores, American Society of Anesthesiologists grades, Charlson Comorbidity Index scores and validated patient-reported outcome measures specific to knee surgery.
Results:
A total of 141 patients were included in this study. Self-Administered Comorbidity Questionnaire scores were directly correlated with American Society of Anesthesiologists grade (rho = 0.37, p < 0.001) and Charlson Comorbidity Index scores (rho = 0.19, p = 0.047). Individual American Society of Anesthesiologists grades had significantly different Self-Administered Comorbidity Questionnaire scores (p = 0.001). Self-Administered Comorbidity Questionnaire scores were specifically associated with hypertension, ischaemic heart disease, chronic obstructive pulmonary disease and the total number of comorbidities, but American Society of Anesthesiologists and Charlson Comorbidity Index scores were associated with more comorbidities. Overall, Self-Administered Comorbidity Questionnaire scores were inversely correlated with patient-reported outcome measure scores.
Conclusion:
Self-Administered Comorbidity Questionnaire scores are associated with increasing comorbidity in patients with symptomatic knee osteoarthritis; however, American Society of Anesthesiologists grades and Charlson Comorbidity Index scores had stronger and more abundant associations with comorbidities and patient-reported outcome measure scores. Self-Administered Comorbidity Questionnaires may complement but not replace current objective assessments of comorbidity when evaluating perioperative risk for knee arthroplasty.
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