Can the Charlson Comorbidity Index be used to predict the ASA grade in patients undergoing spine surgery?

Mannion, Anne F.; Bianchi, Giampaolo; Mariaux, Francine; Fekete, Tamás; Reitmeir, Raluca; Moser, Berthold; Whitmore, Robert G.; Ratliff, John K.; Haschtmann, Daniel

doi:10.1007/s00586-020-06595-1

Cited by 20 publications

(22 citation statements)

References 53 publications

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“…When comparing all the significant predictors of increased postoperative complications, ASA class ≥3 was found to be the strongest predictor of risk, even above mFI-5 and mCCI. Previous studies comparing the ASA to the CCI found that they did not stratify evenly, but rather, having an CCI score ≥1 was an equal threshold to having an ASA score ≥3 30,31. With this in mind, it appears that the mCCI and ASA class are not only correlated with each other, but revealed similar levels of predictive valve when accounting for the transition between ASA class and CCI score.…”

Section: Discussionmentioning

confidence: 85%

Can Frailty Indices Predict Surgical Risk in Open Reduction and Fixation of Facial Fractures?

Katz

Alerte

Akhavan

et al. 2022

Journal of Craniofacial Surgery

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Purpose: The present study sought to evaluate whether the mFI-5 and modified Charlson Comorbidity Index (mCCI) are stronger predictors of 30-day postoperative complications after open reduction of facial fractures compared with historic risk proxies. Methods: A retrospective review of the American College of Surgeons’ National Surgical Quality Improvement Program (ACS-NSQIP) database was conducted to investigate patients who underwent open reduction facial fracture surgery between 2013 and 2018. Risk factors including age, smoking status, body mass index (BMI), comorbidities, and American Society of Anesthesiologists (ASA) class were extracted for each patient. The mFI-5 score and mCCI score were calculated based on this data. Univariate logistic regressions were performed (P<0.05) Results: A total of 2667 cases were included. Of these, 2131 (80%) were male. The strongest predictors for overall 30-day complications and complication severity were ASA class ≥3 (Odds Ratio [OR]=3.34), comorbidities ≥2 (OR=2.78), mCCl score ≥2 (OR=2.19), and mFI-5 ≥1 (OR=1.96). Smoking status and BMI were not strong predictors of total complications or complication severity. Age was found to be a statically significant, but low-impact, predictor of complications, and severity (OR=1.02, P<0.001). The only significant predictors of surgical site infections (SSI) were smoking status (OR=1.56) and ASA class ≥3 (OR=2.40). mFI-5 ≥1 was a significant predictor of hospital readmission. BMI was not associated with any increased risk. Conclusions: The mCCI and mFI-5 are statistically significant predictors of total complications and complication severity in open reduction of facial fracture repair, and thus provide a tool to inform decision making and improve care. Smoking status may increase risk for SSIs following facial fracture repair.

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Section: Discussionmentioning

confidence: 85%

Can Frailty Indices Predict Surgical Risk in Open Reduction and Fixation of Facial Fractures?

Katz

Alerte

Akhavan

et al. 2022

Journal of Craniofacial Surgery

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“…Comorbidity is an established risk factor for complications during spine surgery [ 27 , 38 ]. In 1987, Charlson et al [ 8 ] developed an age-based CCI score, but subsequent studies showed that age and CCI should be examined separately in multivariable predictor analyses of surgical outcomes, especially with large sample sizes [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

Central Sarcopenia, Frailty and Comorbidity as Predictor of Surgical Outcome in Elderly Patients with Degenerative Spine Disease

Kim

Park

Lee

et al. 2021

J Korean Neurosurg Soc

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Objective : People are living longer and the elderly population continues to increase. The incidence of degenerative spinal diseases (DSDs) in the elderly population is quite high. Therefore, we are facing more cases of DSD and offering more surgical solutions in geriatric patients. Understanding the significance and association of frailty and central sarcopenia as risk factors for spinal surgery in elderly patients will be helpful in improving surgical outcomes. We conducted a retrospective cohort analysis of prospectively collected data to assess the impact of preoperative central sarcopenia, frailty, and comorbidity on surgical outcome in elderly patients with DSD. Methods : We conducted a retrospective analysis of patients who underwent elective spinal surgery performed from January 1, 2019 to September 30, 2020 at our hospital. We included patients aged 65 and over who underwent surgery on the thoracic or lumbar spine and were diagnosed as DSD. Central sarcopenia was measured by the 50th percentile of psoas : L4 vertebral index (PLVI) using the cross-sectional area of the psoas muscle. We used the Korean version of the fatigue, resistance, ambulation, illnesses, and loss of weight (K-FRAIL) scale to measure frailty. Comorbidity was confirmed and scored using the Charlson Comorbidity Index (CCI). As a tool for measuring surgical outcome, we used the Clavien-Dindo (CD) classification for postoperative complications and the length of stay (LOS). Results : This study included 85 patients (35 males and 50 females). The mean age was 74.05±6.47 years. Using the K-FRAIL scale, four patients were scored as robust, 44 patients were pre-frail and 37 patients were frail. The mean PLVI was 0.61±0.19. According to the CD classification, 50 patients were classified as grade 1, 19 as grade 2, and four as grade 4. The mean LOS was 12.35±8.17 days. Multivariate stepwise regression analysis showed that postoperative complication was significantly associated with surgical invasiveness and K-FRAIL scale. LOS was significantly associated with surgical invasiveness and CCI. K-FRAIL scale showed a significant correlation with CCI and PLVI. Conclusion :The present study demonstrates that frailty, comorbidity, and surgical invasiveness are important risk factors for postoperative complications and LOS in elderly patients with DSD. Preoperative recognition of these factors may be useful for perioperative optimization, risk stratification, and patient counseling.

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“…The ASA scores [33] is a widely used grading system for preoperative health of the surgical patients, which was correlated, for neurosurgical procedures, with non-neurological morbidity [16,24,30,[35][36][37], postoperative length of stay [18] and survival [41]. The modi ed Frailty index [25]and the Charlson comorbidity index [9] were also studied in the neurosurgical literature with interesting results, especially concerning their highest accuracy for predicting postoperative complications compared to the ASA score [15,22,43]. Youngerman et al, published a large cohort of 9149 patients who underwent oncologic neurosurgery procedures with an estimation of the modi ed Frailty index [44].…”

Section: Discussionmentioning

confidence: 99%

Does general comorbidity impact the postoperative outcomes after surgery for large and giant petroclival meningiomas?

et al. 2021

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ObjectiveWe assessed the role of the general condition of the patient in addition to usual anatomical reasoning to improve the prediction of personalized surgical risk for patients harbouring a large and giant petroclival meningiomas. MethodsSingle-center, retrospective observational study including adult patients surgically treated for a large and giant petroclival meningioma between January 2002 and October 2019 in a French tertiary neurosurgical skull-base center by one Neurosurgeon. Inclusion criteria were: 1) histopathologically proven meningioma; 2) larger than 3cm in diameter; 2) located within the upper two-thirds of the clivus, the inferior petrosal sinus, or the petrous apex around the trigeminal incisura, medial to the trigeminal nerve. Clinical and radiological characteristics were gathered preoperatively including ASA score, the modi ed Frailty Index and the Charlson Comorbidity Index. Post-operative severe neurological and nonneurological complications were collected. ResultsA total of 102 patients harbouring a large and giant petroclival meningioma were included. The rate of postoperative death was 3.0% related to a congestive heart failure (n=1), a surgical site hematoma (n=1), and an ischemic stroke (n=1). A severe neurological impairment was found in 12.8% and a severe nonneurological morbidity was found in 4.0%. The overall rate of severe morbidity and mortality was 15.7% after large and giant petroclival meningioma surgery. The presence of brainstem peri-tumoral edema (adjusted OR,], p=0.028) was independently associated with a history of postoperative severe neurological morbidity. Male gender (adjusted OR, 7.42 [95% CI 1.05-49.77], p=0.044), major cardiovascular morbidity (adjusted OR, 9.5 [95% CI 1.05-86.72], p=0.045), and an ASA score ≥ 2 (adjusted OR, 11.09 [95% CI 1.46-92.98], p=0.038) were independently associated with a history of postoperative severe non-neurological morbidity. A modi ed Frailty index ≥ 1 (adjusted OR, 3.13 [95% CI 1.07-9.93], p=0.047), and a low neurosurgical experience (adjusted OR,.97], p=0.007) were independently associated with a history of postoperative overall morbidity and mortality. ConclusionsThis study suggests to add scores assessing the patient general condition in daily practice to improve the selection of patients eligible for surgery. Collaborative international multicenter studies will be necessary to con rm these results and allow their implementation in clinical routine.

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Can the Charlson Comorbidity Index be used to predict the ASA grade in patients undergoing spine surgery?

Cited by 20 publications

References 53 publications

Can Frailty Indices Predict Surgical Risk in Open Reduction and Fixation of Facial Fractures?

Can Frailty Indices Predict Surgical Risk in Open Reduction and Fixation of Facial Fractures?

Central Sarcopenia, Frailty and Comorbidity as Predictor of Surgical Outcome in Elderly Patients with Degenerative Spine Disease

Does general comorbidity impact the postoperative outcomes after surgery for large and giant petroclival meningiomas?

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