Validation of the Charlson comorbidity index in patients undergoing revision total hip arthroplasty

Schmolders, Jan; Friedrich, M; Michel, Robert D.; Strauß, Andreas C.; Wimmer, Matthias; Randau, Thomas M.; Pennekamp, P. H.; Wirtz, Dieter Christian; Gravius, Sascha

doi:10.1007/s00264-015-2810-y

Cited by 60 publications

(37 citation statements)

References 28 publications

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“…Myocardial infarction, congestive heart failure, mild liver disease and renal disease increase the risk of IHPC. These findings are consistent with those of previous studies [ 17 , 35 – 37 ]. Koenig et al [ 36 ] found that both age and CCI were independent predictors of major adverse events after RHA (adjusted OR, 1.04; 95%CI, 1.00–1.07; and adjusted OR, 1.22; 95%CI, 1.03–1.45, respectively).…”

Section: Discussionsupporting

confidence: 94%

Type 2 diabetes and in-hospital complications after revision of total hip and knee arthroplasty

et al. 2017

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PurposeTo assess the effect of type 2 diabetes (T2DM) on hospital outcomes such as in hospital postoperative complications (IHPC), length of hospital stay (LOHS) and in-hospital mortality (IHM) after the revision of total hip arthroplasty (RHA) and total knee arthroplasty (RKA) and to identify factors associated with IHPC among T2DM patients undergoing these procedures.MethodsWe performed a retrospective study using the Spanish National Hospital Discharge Database, 2005–2014. We included patients who were ≥40 years old that had undergone RHA and RKA. For each T2DM patient, we selected a year-, gender-, age- and Charlson Comorbidity Index-matched non-diabetic patient.ResultsWe identified 44,055 and 39,938 patients who underwent RHA (12.72% with T2DM) and RKA (15.01% with T2DM). We matched 4,700 and 5,394 couples with RHA and RKA, respectively. Any IHPC was more frequent among patients with T2DM than among non-T2DM patients (19% vs. 15.64% in the RHA cohort and 12.94% vs. 11.09% in the RKA cohort, respectively). For patients who underwent RHA, postoperative infection (4.51% vs. 2.94%, p<0.001), acute post-hemorrhagic anemia (9.53% vs. 7.70%, p<0.001), mean LOHS and IHM were significantly higher in patients with T2DM. Among RKA patients, the incidence of acute posthemorrhagic anemia (7.21% vs. 5.62%; p = 0.001) and urinary tract infection (1.13% vs. 0.72%; p = 0.029) was significantly higher in patients with diabetes. Older age, obesity, infection due to internal joint prosthesis, myocardial infarction, congestive heart failure, mild liver disease and renal disease and emergency room admission were significantly associated with a higher risk of IHPC in T2DM patients. IHPC decreased over time only in T2DM patients who underwent RHA (OR 0.94, 95%CI 0.89–0.98).ConclusionsPatients with T2DM who underwent RHA and RKA procedures had more IHPC after controlling for the effects of possible confounders. LOHS and IHM were also higher among RHA patients with diabetes. Older age, comorbidity, obesity and emergency room admission were strong predictors of IHPC in diabetic patients.

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Section: Discussionsupporting

confidence: 94%

Type 2 diabetes and in-hospital complications after revision of total hip and knee arthroplasty

et al. 2017

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“…The number of patients with each Charlson Comorbidity Index (CCI) was also obtained with the mean, median, and SD. This information can be used to estimate 10-year mortality [8], and CCI has been validated in revision THA [37].…”

Section: Methodsmentioning

confidence: 99%

Complications Are Not Increased With Acetabular Revision of Metal-on-metal Total Hip Arthroplasty

Penrose

Seyler

Wellman

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Isolated revision of the acetabular component in the setting of total hip arthroplasty has an increased risk of dislocation. With local soft tissue destruction frequently associated with failed metal-on-metal (MoM) bearings, it is presumed that acetabular revision of these hips will have even greater risk of complications. However, no study directly compares the complications of MoM with metal-on-polyethylene (MoP) acetabular revisions. Questions/purposes In the context of a large database analysis, we asked the following questions: (1) Are there differences in early medical or wound complications after isolated acetabular revision of MoM and MoP bearing surfaces? (2) Are there differences in the frequency of dislocation, deep infection, and rerevision based on the bearing surface of the original implant? Methods A review of the 100% Medicare database from 2005 to 2012 was performed using International Classification of Diseases, 9th Revision and Current Procedural Terminology codes. We identified 451 patients with a MoM bearing and 628 patients with a MoP bearing who had an isolated acetabular revision and a minimum followup of 2 years. The incidence, odds ratios, and 95% confidence intervals for early medical or wound complications were calculated using a univariate analysis at 30 days with patient sex and age group-adjusted analysis for blood transfusion. The incidence, odds ratio, and 95% confidence intervals for dislocation, deep infection, and rerevision were calculated using a univariate analysis at 30 day, 90 days, 1 year, and 2 years using a subgroup analysis with the Cochran-Mantel-Haenszel test to adjust for patient gender and age groups. Results There were no differences between the MoM and MoP isolated acetabular revisions in the incidence of 30-day local complications.

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“…Studies have shown that these risks of surgery, including both morbidity and mortality, increase with age as well as preoperative comorbidity status. 23,28,32 Both age and comorbidities of the patients in our data set were analyzed to further elucidate the mechanics behind the shift from fasciectomies and fasciotomies to CCH injection. The percentage of patients receiving fasciectomies decreased significantly across all age groups, though by greater amounts in the older populations.…”

Section: Discussionmentioning

confidence: 99%

Trends in the Treatment of Dupuytren Disease in the United States Between 2007 and 2014

Lipman

Carstensen

Deal

2016

Hand (New York, N,Y.)

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Background: Dupuytren disease is a common fibroproliferative disorder. Multiple procedural treatment options are available, with Collagenase Clostridium Histolyticum (CCH) injection being introduced in 2010. The purpose of this study was to investigate trends in the treatment of Dupuytren disease in the United States between 2007 and 2014. Methods: The PearlDiver Humana database was queried using International Classification of Diseases, Ninth Revision (ICD-9) and Current Procedural Terminology (CPT) codes for patients with Dupuytren disease that received percutaneous needle aponeurotomy (PNA), fasciotomy, fasciectomy, and CCH injection. Patients were filtered by age, number of comorbidities, and gender. Change in composition of treatments over time was analyzed for each demographic group between 2007 and 2014. Results: Patients presenting to clinic for Dupuytren disease increased from 1118 to 3280, with unchanging treatment percentage of 41. Percent fasciotomies and fasciectomies decreased from 5% to 3% and 33% to 21%, while CCH injection increased to 11% by 2012 to 2014. Percent fasciotomies decreased (P < .05) in younger healthier (age <65, 0-1 comorbidities) and older less healthy (age 65-74, 4+ comorbidities) populations. Percent fasciectomies decreased significantly in nearly all age and comorbidity groups, but by greater amounts in patients with 2+ comorbidities with increasing age. Percent CCH injections increased in all groups, at rates similar to the losses seen in open procedures. Conclusions: CCH injections have risen to substantial levels, with corresponding decreases in the percentage of patients receiving fasciotomies and fasciectomies. Patient age, comorbidities, and gender appear to have influence on the treatment chosen, likely due to their effects on surgical risk and the importance of timely return to activity.

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Validation of the Charlson comorbidity index in patients undergoing revision total hip arthroplasty

Abstract: In summary, we conclude that the CCI and the age-related CCI are strong predictors regarding complication rate in patients undergoing RTHA. In a short- to mid-term follow-up, no influence on implant survival is detectable.

Cited by 60 publications

References 28 publications

Type 2 diabetes and in-hospital complications after revision of total hip and knee arthroplasty

Type 2 diabetes and in-hospital complications after revision of total hip and knee arthroplasty

Complications Are Not Increased With Acetabular Revision of Metal-on-metal Total Hip Arthroplasty

Trends in the Treatment of Dupuytren Disease in the United States Between 2007 and 2014

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