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Clinical Orthopaedics and Related Research®

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01-05-2014 | Clinical Research

Higher Charlson Comorbidity Index Scores are Associated With Readmission After Orthopaedic Surgery

Authors: Timothy Voskuijl, MD, Michiel Hageman, MD, David Ring, MD, PhD

Published in: Clinical Orthopaedics and Related Research® | Issue 5/2014

Abstract

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

Available only for authorised users

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Title: Higher Charlson Comorbidity Index Scores are Associated With Readmission After Orthopaedic Surgery
Authors: Timothy Voskuijl, MD
Michiel Hageman, MD
David Ring, MD, PhD
Publication date: 01-05-2014
Publisher: Springer US
Published in: Clinical Orthopaedics and Related Research® / Issue 5/2014
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI: https://doi.org/10.1007/s11999-013-3394-8

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Springer Medicine

Higher Charlson Comorbidity Index Scores are Associated With Readmission After Orthopaedic Surgery

Abstract

Background

Questions/purposes

Methods

Results

Conclusions

Level of Evidence

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Questions/purposes

Methods

Results

Conclusions

Level of Evidence

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