背景:有许多工具可以帮助外科医生进行风险评估,包括Charlson合并症指数(CCI),Elixhauser合并症指数(ECI),和各种脆弱的措施,如医院衰弱风险评分(HFR)。虽然所有这些工具都已经过通用验证,最佳风险评估工具仍在争论中。风险评估在择期手术中尤为重要,如全关节置换术。这项研究的目的是比较CCI,ECI和HFR在全膝关节置换术(TKA)中的预测能力。
方法:所有接受TKA的患者均通过国际疾病和相关健康问题统计分类进行鉴定,来自国家再招生数据库的第十次修订代码,2016年至2019年。患者人口统计学,围手术期并发症,并记录与医院相关的结局.建立受试者工作特征(ROC)曲线,并评估曲线下面积(AUC)以衡量每个风险评估工具(CCI、ECI和HFR)在一系列结果中的预测能力。
结果:共有1,930,803例接受TKA的患者纳入我们的分析。对于死亡率,ECI最具预测性(0.95AUC),而HFR和CCI分别为0.75和0.74AUC,分别。对于假体周围骨折,ECI为0.78AUC,HFR为0.68AUC,CCI为0.66AUC。对于关节感染,ECI为0.78AUC,HFR为0.63AUC,CCI为0.62AUC。再入院30天,ECI为0.79AUC,而HFR和CCI为0.6AUC。再手术30天,ECI为0.69AUC,而HFR为0.58AUC,CCI为0.56AUC。
结论:我们的分析表明,在预测TKA术后30天预后方面,ECI优于CCI和HFR。外科医生应考虑在TKA之前使用ECI评估患者。
BACKGROUND: A number of tools exist to aid surgeons in risk assessment, including the Charlson Comorbidity Index (CCI), the Elixhauser Comorbidity Index (ECI), and various measures of frailty, such as the Hospital Frailty Risk Score (HFR). While all of these tools have been validated for general use, the best risk assessment tool is still debated. Risk assessment is particularly important in elective surgery, such as total joint arthroplasty. The aim of this study is to compare the predictive power of the CCI, ECI, and HFR in the setting of total knee arthroplasty (TKA).
METHODS: All patients who underwent TKA were identified via International Statistical Classification of Diseases and Related Health Problems, Tenth Revision code from the National Readmissions Database, years 2016 to 2019. Patient demographics, perioperative complications, and hospital-associated outcomes were recorded. Receiver operating characteristic (ROC) curves were created and area under the curves (AUCs) evaluated to gauge the predictive capabilities of each risk assessment tool (CCI, ECI, and HFR) across a range of outcomes.
RESULTS: A total of 1,930,803 patients undergoing TKA were included in our analysis. For mortality, ECI was most predictive (0.95 AUC), while HFR and CCI were 0.75 and 0.74 AUC, respectively. For periprosthetic fractures, ECI was 0.78 AUC, HFR was 0.68 AUC, and CCI was 0.66 AUC. For joint infections, the ECI was 0.78 AUC, the HFR was 0.63 AUC, and the CCI was 0.62 AUC. For 30-day readmission, ECI was 0.79 AUC, while HFR and CCI were 0.6 AUC. For 30-day reoperation, ECI was 0.69 AUC, while HFR was 0.58 AUC and CCI was 0.56 AUC.
CONCLUSIONS: Our analysis shows that ECI is superior to CCI and HFR for predicting 30-day postoperative outcomes following TKA. Surgeons should consider assessing patients using ECI prior to TKA.