Danderyd Hospital, Division of Orthopaedics, Department of Clinical Sciences, Karolinska Institute, Danderyds Sjukhus, SE-182 88 Stockholm, Sweden.
Bone Joint J. 2013 Sep;95-B(9):1184-91. doi: 10.1302/0301-620X.95B9.31006.
While an increasing amount of arthroplasty articles report comorbidity measures, none have been validated for outcomes. In this study, we compared commonly used International Classification of Diseases-based comorbidity measures with re-operation rates after total hip replacement (THR). Scores used included the Charlson, the Royal College of Surgeons Charlson, and the Elixhauser comorbidity score. We identified a nationwide cohort of 134 423 THRs from the Swedish Hip Arthroplasty Register. Re-operations were registered post-operatively for up to 12 years. The hazard ratio was estimated by Cox's proportional hazards regression, and we used C-statistics to assess each measure's ability to predict re-operation. Confounding variables were age, gender, type of implant fixation, hospital category, hospital implant volume and year of surgery. In the first two years only the Elixhauser score showed any significant relationship with increased risk of re-operation, with increased scores for both one to two and three or more comorbidities. However, the predictive C-statistic in this period for the Elixhauser score was poor (0.52). None of the measures proved to be of any value between two and 12 years. They might be of value in large cohort or registry studies, but not for the individual patient.
虽然越来越多的关节置换术文章报告了合并症的衡量标准，但没有一种方法被证实可以预测手术结果。在这项研究中，我们比较了常用于全髋关节置换术（THR）的国际疾病分类（ICD）为基础的合并症衡量标准与再次手术率。使用的评分包括 Charlson 评分、皇家外科学院 Charlson 评分和 Elixhauser 合并症评分。我们从瑞典髋关节置换登记处确定了一个全国性的 134423 例 THR 队列。手术后最多 12 年内进行再次手术登记。使用 Cox 比例风险回归估计风险比，我们使用 C 统计量评估每种方法预测再次手术的能力。混杂变量包括年龄、性别、植入物固定类型、医院类别、医院植入物数量和手术年份。在前两年，只有 Elixhauser 评分与再次手术风险增加有显著关系，一个到两个和三个或更多合并症的评分都会增加。然而，在这个时期，Elixhauser 评分的预测 C 统计量较差（0.52）。在两年到 12 年之间，没有一种方法被证明有任何价值。它们可能在大型队列或登记研究中有用，但对个体患者没有价值。
