Reporting of Comorbidities in Total Hip and Knee Arthroplasty Clinical Literature

Abstract

Background:The effects of comorbid disease remain an area of interest. Concurrent diagnoses not only affect clinical outcomes but also affect health-care reimbursement. As the rate of arthroplasty increases, consistent risk stratification is imperative. Therefore, our aim was to ascertain how comorbidities have been reported in the recent total hip arthroplasty (THA) and total knee arthroplasty (TKA)-related literature; we also wanted to quantify the use of comorbidity scores for the assessment of comorbid disease in arthroplasty research.Methods:A systematic review of the recent THA and TKA literature that was published between January 1, 2019, and September 21, 2020, was performed using the PubMed and MEDLINE databases. Clinical studies that provided data on comorbidities were evaluated for method of comorbidity reporting. The prevalence of comorbidity reporting was assessed, and the manner of reporting was analyzed.Results:Among 659 articles, a total of 207 studies (31.4%) reported comorbidities and met our inclusion criteria. Of the 207 studies that reported comorbidities, only 57% used a comorbidity index to report comorbid disease. Of all of the indices, the American Society of Anesthesiologists (ASA) Physical Status Classification System was the score that was most commonly used (TKA, 86.2%; THA, 83.3%). Additional scores were used at varying frequencies. For TKA, the scores included the Charlson Comorbidity Index (CCI) (15.5%); the New York Heart Association (NYHA) Functional Classification (3.4%); and the CCI-Deyo (adapted by Deyo et al.), the age-adjusted CCI, the Cumulative Illness Rating Scale (CIRS), and the Readmission Risk Assessment Tool (RRAT) (1.7% each). For THA, the scores included the CCI (16.7%), the Elixhauser Comorbidity Measure (ECM) (6.7%), and the CCI-Deyo (1.7%).Conclusions:Considering the impact of comorbid disease on outcomes, complications, and, ultimately, reimbursement, standardized risk stratification in arthroplasty is necessary. Current studies demonstrate inconsistent comorbidity reporting, making it challenging to further characterize the impact of comorbidities on outcomes. Future research should target the development of a standardized data-driven model for comorbidity assessment in the orthopaedic patient population.

Racial Disparities in Outcomes After THA and TKA Are Substantially Mediated by Socioeconomic Disadvantage Both in Black and White Patients

“…The CCI was first described by Charlson et al [4] in 1987 and was utilized to predict a patient’s likelihood of 10-year mortality based on their comorbidity burden. The index has been refined since the original publication, and we utilized the quan-10 age-unadjusted scoring system [26]. Data on comorbidities was acquired from our institutional data collection system.…”

Changes in epidemiological characteristics of knee arthroplasty in eastern, northern and central China between 2011 and 2020

“…Presently, there are many related studies investigating the comorbidities of KA patients, mainly including hypertension, diabetes, cardiovascular and cerebrovascular diseases [ 25 , 26 ]. Chikud et al[ 15 ] performed statistical analysis on inpatients from 926 hospitals in Japan from 2007 to 2010 and found that diabetes was the most common comorbidity among 410,60 patients who underwent TKA, accounting for approximately 16%, followed by chronic lung disease (2.6%) and chronic renal failure (1.9%).…”

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?

“…Inconsistence performance and sparse validation of theses indices to predict revision, reoperation, medical complications and mortality were observed. Nevertheless, ASA grade appears to be the most commonly used comorbidity measure in THA showing a strong association with the risk of mortality and early complications after surgery [30]. A few studies comparing several preoperative comorbidity indices found that ASA grade was a better predictive measure than comorbidity indices [3,24,27,31] to predict mortality and very early complications.…”