Prospective Comparison of 6 Comorbidity Indices as Predictors of 1-Year Post-Hospital Discharge Institutionalization, Readmission, and Mortality in Elderly Individuals

Zekry, Dina; Valle, Bernardo Hermont Loures; C, Graf; Michel, Jean‐Pierre; Gold, Gabriel; Krause, Karl‐Heinz; Herrmann, Françoís

doi:10.1016/j.jamda.2010.11.011

Cited by 63 publications

(63 citation statements)

References 32 publications

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“…This is consistent with studies of medical patients [30,37]. A retrospective study of readmission of general medicine patients admitted from the emergency department revealed a hazard ratio of 1.42 (95% CI, 1.07-1.89) for patients with a Charlson score of 2 to 4 and a hazard ratio of 1.93 (95% CI, 1.37-2.73) for patients with a Charlson score higher than 4 [30].…”

Section: Discussionsupporting

confidence: 87%

“…A retrospective study of readmission of general medicine patients admitted from the emergency department revealed a hazard ratio of 1.42 (95% CI, 1.07-1.89) for patients with a Charlson score of 2 to 4 and a hazard ratio of 1.93 (95% CI, 1.37-2.73) for patients with a Charlson score higher than 4 [30]. A prospective study on geriatric patients revealed that 3.1% of the variation in readmission in their study-population was explained by the CCI [37]. In our study, the CCI was not related to repeat surgery for adverse events or surgical site infection.…”

Section: Discussionmentioning

confidence: 98%

“…With the economic penalties associated with readmission after surgery with the Hospital Readmissions Reduction Program [6,16,19], there now are financial and professional incentives to improve our ability to anticipate complications of treatment. The CCI has been used as a predictor for adverse events [2,9,17,30,[32][33][34]37]. Our study addressed the association of comorbidities as measured by the CCI on readmission and adverse outcomes after orthopaedic surgeries.…”

Section: Discussionmentioning

confidence: 99%

“…A higher CCI indicates a higher risk of death within 1 year. The CCI also has been evaluated as a predictor for outcomes after orthopaedic trauma surgery, postoperative adverse events after general surgery, and readmission for geriatric and general medicine patients [2,9,17,30,[32][33][34]37].…”

Section: Introductionmentioning

confidence: 99%

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Higher Charlson Comorbidity Index Scores are Associated With Readmission After Orthopaedic Surgery

Voskuijl

Hageman

Ring

2014

Clinical Orthopaedics &Amp; Related Research

178

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Background The Charlson Comorbidity Index (CCI) originally was developed to predict mortality within 1 year of hospital admission in patients without trauma. As it includes factors associated with medical and surgical complexities, it also may be useful as a predictive tool for hospital readmission after orthopaedic surgery, but to our knowledge, this has not been studied. Questions/purposes We asked whether an increased score on the CCI was associated with (1) readmission, (2) an increased risk of surgical site infection or other adverse events, (3) transfusion risk, or (4) mortality after orthopaedic surgery. Methods A total of 30,129 orthopaedic surgeries performed between 2008 and 2011 without any orthopaedic surgery in the preceding 30 days were analyzed. International Classification of Diseases, 9 th Revision codes were used to identify diagnoses, procedures, surgery-related adverse events, surgical site infection, and comorbidities as listed in the updated and reweighted CCI. A total of 913 patients (3.0%) were readmitted within 30 days after discharge; in 393 (1.4%) patients adverse events occurred; 417 patients (1.4%) had a surgical site infection develop; 211 (0.7%) needed transfusions, and 56 (0.2%) died within 30 days after surgery. Ordinary least squares regression analyses were used to determine whether the CCI was associated with these outcomes. Results The CCI accounted for 10% of the variation in readmissions. Every point increase in CCI score added an additional 0.45% risk in readmission for patients undergoing arthroplasty, 0.63% for patients undergoing trauma surgery, and 0.9% risk for patients undergoing spine surgery (all p \ 0.01). The CCI was not associated with surgical site infection or other adverse events, but accounted for 8% of the variation in transfusion rate and 10% of the variation in mortality within 30 days of surgery. Conclusions The CCI can be used to estimate the risk of readmission after arthroplasty, hand and upper extremity surgery, spine surgery, and trauma surgery. It also can be used to estimate the risk of transfusion after arthroplasty, spine, trauma, and oncologic orthopaedic surgery and the risk of mortality after shoulder, trauma, and oncologic orthopaedic surgery.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Higher Charlson Comorbidity Index Scores are Associated With Readmission After Orthopaedic Surgery

Voskuijl

Hageman

Ring

2014

Clinical Orthopaedics &Amp; Related Research

178

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“…To date, there has been no consensus on the definition of comorbidity yet, but the core concept is the coexistence of more than one condition in the same patient [59]. Evidence shows that the top primary diagnoses of potentially avoidable readmissions are often possible complications of a comorbidity [60] and higher comorbidity has been linked to increased readmission risks [61,62]. In readmission predictions, comorbidities are represented either in the form of the number of comorbidities, the comorbidity index, or the presence of a comorbid condition.…”

Section: Comorbidities Conditions Lab Tests and Medicationsmentioning

confidence: 99%

A Systematic Review of Highly Generalizable Risk Factors for Unplanned 30-Day All-Cause Hospital Readmissions

Zhao¹,

Yoo²

2017

J Health Med Inform

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Background: Hospital readmissions are common and expensive. Numerous global efforts have been devoted to predicting readmissions. However, for many reasons including the variations in the studied populations and inconsistent definitions of readmissions, the outcomes of some studies can hardly be generalized to other studies inside or outside the same country or region. Objective:The objective was to identify highly generalizable risk factors for unplanned 30-day all-cause hospital readmissions to guide the selection of baseline predictor variables in different readmission studies.Methods: In July 2017, PubMed was searched to identify articles pertaining to the risk factors for unplanned 30-day all-cause hospital readmissions. To identify potentially eligible risk factors, characteristics of the selected studies were manually extracted. The generalizability of the risk factors was assessed with predefined criteria.Results: 13 articles were eligible for the review. A total of 42 risk factors were identified and 34 of them were found to be highly generalizable. Conclusions:The 34 risk factors are not specific to any populations or places, and the corresponding predictor variables can serve as baseline variables in readmission prediction studies. No major difference has been observed between the risk factors identified inside and outside the United States except that US studies appeared to prefer composite comorbidity measures. All the reviewed studies have used traditional statistical regression-based methods to identify risk factors and more applications of data mining techniques are expected in this field.

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Survival of people with dementia after unplanned acute hospital admission: a prospective cohort study

Sampson

Leurent

Blanchard

et al. 2012

Int J Geriat Psychiatry

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Objective: To examine the effect of dementia on longer term survival after hospital admission, and to assess whether dementia is an independent predictor of mortality. This information is vital for the provision of appropriate care. Methods: A prospective cohort study, in a large urban acute general hospital, of 616 people (70 years and older) with unplanned medical admission. The principal exposure was DSM-IV dementia and main outcome mortality risk. Dementia severity was analysed by using the Functional Assessment Staging scale. We examined a range of modifying variables: acute physiological disturbance (Acute Physiology and Chronic Health Evaluation), chronic comorbidity (Charlson Comorbidity Index, CCI) and pressure sore risk (Waterlow score). Results: A total 42.4% of the cohort had dementia. Nearly half (48.3%) had died 12 months after admission (median survival time 1.1 years compared with 2.7 years in people without dementia). Unadjusted hazard ratios for mortality in people with dementia was 1.66 (95% CI 1.35-2.04) and for people with moderately severe/severe dementia 2.01 (95% CI 1.57-2.57). After sequential adjustment (age, gender, Acute Physiology and Chronic Health Evaluation score, Charlson Comorbidity Index and Waterlow score), patients with dementia had a mortality risk of 1.24 (95% CI 0.95-1.60) and those with moderately severe/severe dementia 1.33 (0.97-1.84). Conclusions: People with dementia had half the survival time of those without dementia. The effect of dementia on mortality was reduced after adjustment, particularly by the Waterlow score, a marker of frailty. The median survival of 1 year suggests clinicians should consider adopting a supportive approach to the care of older people with moderate/severe dementia who have an emergency hospital admission.

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Prospective Comparison of 6 Comorbidity Indices as Predictors of 1-Year Post-Hospital Discharge Institutionalization, Readmission, and Mortality in Elderly Individuals

Cited by 63 publications

References 32 publications

Higher Charlson Comorbidity Index Scores are Associated With Readmission After Orthopaedic Surgery

Higher Charlson Comorbidity Index Scores are Associated With Readmission After Orthopaedic Surgery

A Systematic Review of Highly Generalizable Risk Factors for Unplanned 30-Day All-Cause Hospital Readmissions

Survival of people with dementia after unplanned acute hospital admission: a prospective cohort study

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