Higher Charlson Comorbidity Index Scores Are Associated With Increased Hospital Length of Stay After Lower Extremity Orthopaedic Trauma

Lakomkin, Nikita; Kothari, Parth; Dodd, Ashley C.; VanHouten, Jacob P.; Yarlagadda, Mahesh; Collinge, Cory; Obremskey, William T.; Sethi, Manish K.

doi:10.1097/bot.0000000000000701

Cited by 46 publications

(28 citation statements)

References 30 publications

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“…Thus, our finding of increased comorbidity burden and lower pain levels should be interpreted cautiously. With respect to rehabilitation LOS, however, our findings are consistent with prior studies that have shown that the CCI can be used as a predictive tool . As the medical complexity of a patient increases, the possibility that a comorbid condition is exacerbated or contributory to decreased physical tolerance increases.…”

Section: Discussionsupporting

confidence: 89%

A Retrospective Study of the Association between Pain Intensity and Opioid Use with Length of Stay during Musculoskeletal Inpatient Rehabilitation after Primary Knee and Hip Arthroplasty

Sahota

Alavinia

Kumbhare

et al. 2019

PM&R

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Background: The relationship between pain intensity, opioid consumption, and length of stay (LOS) has received little attention in primary, lower extremity joint arthroplasty patients admitted to inpatient musculoskeletal rehabilitation. Objective: To assess how initial pain and other clinical factors are associated with rehabilitation LOS. Design: Retrospective chart review. Setting: Rehabilitation hospital. Participants: One hundred ninety nine patients admitted for inpatient rehabilitation. Interventions: Not Applicable. Main Outcome Measures: Pain intensities on the Numeric Rating Scale (NRS) were completed 3 times daily and total daily opioid consumption recorded in terms of morphine equivalents (MEQ). Confounding variables included patient demographics, medical comorbidity burden using the Charlson Comorbidity Index (CCI), and early functional status as measured by the motor subscale from the Functional Independence Measure (FIM). Results: Mean day 3 NRS values of ≥5.2 and total day 3 opioid consumption of >50 MEQ were associated with a prolonged LOS by nearly 3 and 2 days, respectively. Within a multivariate linear regression, age, mean day 3 pain, comorbidity burden, and early motor functional status accounted for 36% of the variability seen in joint replacement rehabilitation LOS. With all other variables remaining constant, for every unit increase in mean day 3 pain and CCI, this amounted to an additional 5% and 4% increase to LOS, whereas each unit increase in admission motor FIM decreased estimated LOS by 3%. Conclusion: Mean pain intensity and total opioid consumption on day 3 of inpatient rehabilitation is associated with LOS. For the rehabilitation physician, this is useful information as the earlier identification of patients with poorly controlled pain can lead to directed intervention, better patient care, and significant cost savings.

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Section: Discussionsupporting

confidence: 89%

A Retrospective Study of the Association between Pain Intensity and Opioid Use with Length of Stay during Musculoskeletal Inpatient Rehabilitation after Primary Knee and Hip Arthroplasty

Sahota

Alavinia

Kumbhare

et al. 2019

PM&R

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“…Our results also indicate that CCI is associated with longer LOS and higher hospitalisation costs in Australia. CCI has previously been found to predict LOS in stroke patients [ 39 ], as well as in patients with cancer [ 38 ], sepsis, or those undergoing surgical procedures [ 40 ]. Among patients hospitalised for hip fracture in the USA, Johnson and colleagues [ 41 ], observed that patients with a CCI score of 2, on average, stayed 1.92 extra days in the hospital and incurred USD$8698 extra costs compared to those with a CCI score of 0.…”

Section: Discussionmentioning

confidence: 99%

Effect of Comorbidity Assessed by the Charlson Comorbidity Index on the Length of Stay, Costs and Mortality among Older Adults Hospitalised for Acute Stroke

Ofori‐Asenso

Zomer

Chin

et al. 2018

IJERPH

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The burden of comorbidity among stroke patients is high. The aim of this study was to examine the effect of comorbidity on the length of stay (LOS), costs, and mortality among older adults hospitalised for acute stroke. Among 776 older adults (mean age 80.1 ± 8.3 years; 46.7% female) hospitalised for acute stroke during July 2013 to December 2015 at a tertiary hospital in Melbourne, Australia, we collected data on LOS, costs, and discharge outcomes. Comorbidity was assessed via the Charlson Comorbidity Index (CCI), where a CCI score of 0–1 was considered low and a CCI ≥ 2 was high. Negative binomial regression and quantile regression were applied to examine the association between CCI and LOS and cost, respectively. Survival was evaluated with the Kaplan–Meier and Cox regression analyses. The median LOS was 1.1 days longer for patients with high CCI than for those with low CCI. In-hospital mortality rate was 18.2% (22.1% for high CCI versus 11.8% for low CCI, p < 0.0001). After controlling for confounders, high CCI was associated with longer LOS (incidence rate ratio [IRR]; 1.35, p < 0.0001) and increased likelihood of in-hospital death (hazard ratio [HR]; 1.91, p = 0.003). The adjusted median, 25th, and 75th percentile costs were AUD$2483 (26.1%), AUD$1446 (28.1%), and AUD$3140 (27.9%) higher for patients with high CCI than for those with low CCI. Among older adults hospitalised for acute stroke, higher global comorbidity (CCI ≥ 2) was associated adverse clinical outcomes. Measures to better manage comorbidities should be considered as part of wider strategies towards mitigating the social and economic impacts of stroke.

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“…Preoperative steroid use may be related to the relatively more preoperative comorbidities found in the patients. Studies on lower extremity fracture surgeries revealed that the CCI was positively correlated with the number of days that patients were hospitalized, [35,36] and that on average, patients with a CCI of 2 spent 1.92 more days in hospitals than those with a CCI of 0. [35] For type of anesthesia received, the effects of general and regional anesthesia on overall postoperative complications and the length of stay were inconclusive.…”

Section: Discussionmentioning

confidence: 99%

Do rheumatoid arthritis patients have more major complications and length of stay after lower extremities fracture surgery?

Hsu

Kung

et al. 2019

Medicine

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Patients with rheumatoid arthritis (RA) have a high risk of cardiovascular diseases and fractures. This retrospective cohort study explored whether patients with RA face higher complication risks or longer hospital stays than other patients when they had a lower limb fracture that required the surgery. Patients aged >45 years who received lower limb fracture surgeries between 2005 and 2012 were selected from the National Health Insurance Research Database, and 10 related variables including sex and age were used in propensity score matching to pair RA patients with non-RA patients in a 1:4 ratio. The final study sample comprised 1109 patients with RA and 4436 non-RA patients. The results indicated that 5.57% of the study sample had postoperative complications, accounting for 5.05% of patients with RA and 5.70% of the control group. After conditional logistic regression analysis was performed, the risk of major complications has no significant differences between patients with RA and the control group (odds ratio [OR] = 0.87; 95% confidence interval [CI]: 0.61–1.24; P > .05). However, the comorbidity severity score exerted a significant effect on complications; patients with scores ≥3 were 2.78 times more likely to experience complications (OR = 2.78; 95% CI 1.52–5.07). When considering different types of complications, patients with RA were less likely to be exposed to the risk of stroke (OR = 0.48). After controlling all related factors, no significant differences were observed in the complication risks or deaths between the 2 groups ( P > .05). Regarding hospitalization length, the average stay for all patients was 8.12 days; after controlling related factors, the hospitalization length for patients with RA was 0.97 times that of the control group, which was nonsignificant ( P > .05). These results may provide some information to healthcare professionals when providing treatments.

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Higher Charlson Comorbidity Index Scores Are Associated With Increased Hospital Length of Stay After Lower Extremity Orthopaedic Trauma

Abstract: Prognostic Level III. See Instructions for Authors for a complete.

Cited by 46 publications

References 30 publications

A Retrospective Study of the Association between Pain Intensity and Opioid Use with Length of Stay during Musculoskeletal Inpatient Rehabilitation after Primary Knee and Hip Arthroplasty

A Retrospective Study of the Association between Pain Intensity and Opioid Use with Length of Stay during Musculoskeletal Inpatient Rehabilitation after Primary Knee and Hip Arthroplasty

Effect of Comorbidity Assessed by the Charlson Comorbidity Index on the Length of Stay, Costs and Mortality among Older Adults Hospitalised for Acute Stroke

Do rheumatoid arthritis patients have more major complications and length of stay after lower extremities fracture surgery?

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