Does Preoperative American Society of Anesthesiologists Score Relate to Complications After Total Shoulder Arthroplasty?

Johnson, Christine Cole; Sodha, Sonal; Garzon-Muvdi, Juan; Petersen, Steve A.; McFarland, Edward G.

doi:10.1007/s11999-013-3400-1

Cited by 50 publications

(32 citation statements)

References 48 publications

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“…The degree to which this issue influenced our results is unclear, although it has been reported that the majority of common diagnoses are comorbidities rather than adverse events [15,30,36]. Fourth, the NHDS enabled only ascertainment of inpatient outcomes, and thus postdischarge complications [24,40,58]. Finally, we did not perform any clinical data abstraction from medical records, which is considered the gold standard risk adjustment method in these comparisons [10]; thus, we were able to compare the Charlson and Elixhauser measures only for their relative performance.…”

Section: Discussionmentioning

confidence: 93%

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The Elixhauser Comorbidity Method Outperforms the Charlson Index in Predicting Inpatient Death After Orthopaedic Surgery

Menendez

Neuhaus

Dijk

et al. 2014

Clinical Orthopaedics &Amp; Related Research

431

292

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Background Scores derived from comorbidities can help with risk adjustment of quality and safety data. The Charlson and Elixhauser comorbidity measures are wellknown risk adjustment models, yet the optimal score for orthopaedic patients remains unclear. Questions/purposes We determined whether there was a difference in the accuracy of the Charlson and Elixhauser comorbidity-based measures in predicting (1) in-hospital mortality after major orthopaedic surgery, (2) in-hospital adverse events, and (3) nonroutine discharge. Methods Among an estimated 14,007,813 patients undergoing orthopaedic surgery identified in the National Hospital Discharge Survey (1990Survey ( -2007, 0.80% died in the hospital. The association of each Charlson comorbidity measure and Elixhauser comorbidity measure with mortality was assessed in bivariate analysis. Two main multivariable logistic regression models were constructed, with in-hospital mortality as the dependent variable and one of the two comorbidity-based measures (and age, sex, and year of surgery) as independent variables. A base model that included only age, sex, and year of surgery also was evaluated. The discriminative ability of the models was quantified using the area under the receiver operating characteristic curve (AUC). The AUC quantifies the ability of our models to assign a high probability of mortality to patients who die. Values range from 0.50 to 1.0, with 0.50 indicating no ability to discriminate and 1.0 indicating perfect discrimination. Results Elixhauser comorbidity adjustment provided a better prediction of in-hospital case mortality (AUC, 0.86; 95% CI, 0.86-0.86) compared with the Charlson model (AUC, 0.83; 95% CI, and to the base model with no comorbidities (AUC, 0.81; 95% CI, 0.81-0.81). In terms of relative improvement in predictive performance, the Elixhauser measure performed 60% better than the Charlson score in predicting mortality. The Elixhauser model discriminated inpatient morbidity better than the Charlson measure, but the discriminative ability of the model was poor and the difference in the absolute improvement in predictive power between the two models (AUC, 0.01) is of dubious clinical importance. Both comorbidity models exhibited the same degree of discrimination for estimating nonroutine discharge (AUC, 0.81; 95% CI, 0.81-0.82 for both models). Conclusions Provider-specific outcomes, particularly inpatient mortality, may be evaluated differently depending on the comorbidity risk adjustment model selected. Future research assessing and comparing the performance of the

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Section: Discussionmentioning

confidence: 93%

“…Patients undergoing orthopaedic surgery often have multiple coexisting medical conditions (comorbidities) [13,21,24,28,39,45,58]. Preoperative risk assessment can help with decision-making and management strategies [11,37,50].…”

Section: Introductionmentioning

confidence: 99%

The Elixhauser Comorbidity Method Outperforms the Charlson Index in Predicting Inpatient Death After Orthopaedic Surgery

Menendez

Neuhaus

Dijk

et al. 2014

Clinical Orthopaedics &Amp; Related Research

431

292

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“…[21][22][23][24] Patients with a higher comorbidity burden may have complications stemming directly from their underlying medical disease and are also perhaps more susceptible to complications related to the fracture and subsequent surgery. Increased ASA class indicates severe underlying medical disease, which has been previously found to be associated with increased risk of adverse events after many types of orthopaedic procedures.…”

Section: Discussionmentioning

confidence: 99%

Adverse Events, Length of Stay, and Readmission After Surgery for Tibial Plateau Fractures

Basques

Webb

Bohl

et al. 2015

Journal of Orthopaedic Trauma

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“…Fourth, because we risk adjusted using administrative data alone, we were unable to include other clinically important parameters such as the American Society of Anesthesiologists score, the Frailty Index developed by the Canadian Study of Health and Aging, the Geriatric Index of Comorbidity, the Total Illness Burden Index, or the Functional Comorbidity Index, which may have enhanced model performance. [48][49][50][51][52] Finally, we were only able to compare the Charlson and Elixhauser comorbidity scores in terms of their relative predictive performance, as we did not perform any clinical data abstraction from medical records--the gold-standard risk adjustment method in these comparisons. 20,53 In this study of nationally representative data collected between 2002 and 2011, the Elixhauser comorbidity-based measure outperformed the Charlson index in predicting inpatient mortality after proximal humerus fracture.…”

Section: Discussionmentioning

confidence: 99%

A Comparison of the Charlson and Elixhauser Comorbidity Measures to Predict Inpatient Mortality After Proximal Humerus Fracture

Menendez

Ring

2015

Journal of Orthopaedic Trauma

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Does Preoperative American Society of Anesthesiologists Score Relate to Complications After Total Shoulder Arthroplasty?

Abstract: Background For hip and knee arthroplasties, an Ameri-

Cited by 50 publications

References 48 publications

The Elixhauser Comorbidity Method Outperforms the Charlson Index in Predicting Inpatient Death After Orthopaedic Surgery

The Elixhauser Comorbidity Method Outperforms the Charlson Index in Predicting Inpatient Death After Orthopaedic Surgery

Adverse Events, Length of Stay, and Readmission After Surgery for Tibial Plateau Fractures

A Comparison of the Charlson and Elixhauser Comorbidity Measures to Predict Inpatient Mortality After Proximal Humerus Fracture

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