Comorbidity indices in orthopaedic surgery: a narrative review focused on hip and knee arthroplasty

Abstract

Comorbidity indices currently used to estimate negative postoperative outcomes in orthopaedic surgery were originally developed among non-orthopaedic patient populations. While current indices were initially intended to predict short-term mortality, they have since been used for other purposes as well. As the rate of hip and knee arthroplasty steadily rises, understanding the magnitude of the effect of comorbid disease on postoperative outcomes has become increasingly more important. Currently, the ASA classification is the most commonly used comorbidity measure and is systematically recorded by the majority of national arthroplasty registries. Consideration should be given to developing an updated, standardized approach for comorbidity assessment and reporting in orthopaedic surgery, especially within the setting of elective hip and knee arthroplasty. Cite this article: EFORT Open Rev 2021;6:629-640. DOI: 10.1302/2058-5241.6.200124

Association of preoperative health status with risk of complications after primary total hip arthroplasty: How useful are the measures self-rated health, ASA classification and comorbidity count?

“…Previous studies using objective health measures to predict medical complications and/or mortality have shown that decreased preoperative health status (measured using ASA grade, Charlson comorbidity, Elixhauser comorbidity measure, modi ed Frailty Index) was associated with negative shortterm postoperative outcomes after total joint arthroplasty [3,12,[24][25][26][27][28][29]. Presence of comorbidities has an impact on patient mortality and medical complications but also on hospital resources and reimbursement [10]. Inconsistence performance and sparse validation of theses indices to predict revision, reoperation, medical complications and mortality were observed.…”

“…Comorbidity is an important determinant of outcomes after surgical interventions. In the context of total hip arthroplasty (THA) this was con rmed regarding length of hospital stay, readmission after THA, revision surgery and postoperative mortality [1][2][3][4][5]. Comorbidity refers to one or more other diseases or medical conditions coexisting and not on the causal pathway of the disease of interest and evaluated by the clinician [6].…”

“…To quantify preoperative burden, either ASA classi cation [7], comorbidity count or comorbidity indices are used [8,9]. The most widely used measure is the ASA classi cation [10], which has been related to postoperative complications, readmissions, revisions and reoperations following THA [11][12][13][14].…”

“…To quantify preoperative burden, either ASA classi cation [7], comorbidity count or comorbidity indices are used [8,9]. The most widely used measure is the ASA classi cation [10], which has been related to postoperative complications, readmissions, revisions and reoperations following THA [11][12][13][14].Self-rated health (SRH) [15-17] is a simple tool assessing a patient's self-reported general health over the last four weeks on a ve-point scale [18]. Using a self-administered questionnaire, SRH can be employed to assess general health easily at any point in time.…”

Effects of Sarcopenic Obesity and Its Confounders on Knee Range of Motion Outcome after Total Knee Replacement in Older Adults with Knee Osteoarthritis: A Retrospective Study

“…Such uncontrolled comorbidities may have impacts on an individual's physiologic reserve [50], especially those who are undergoing an acute event (e.q. TKR surgery) [51]; (2) a history of internal cancer requiring surgery, neurological diseases, or falling fracture in legs before six months of surgery; (3) underwent simultaneously bilateral or a revision TKR; (4) patients who had a knee flexion ROM < 125 degrees at inpatient discharge; the details were described in the following (Section 2.6). A flowchart depicting the patient selection process and study group assignment is illustrated in Figure 1.…”