较高的 Charlson 合并症指数评分与骨科手术后再入院相关。
Higher Charlson Comorbidity Index Scores are associated with readmission after orthopaedic surgery.
机构信息
Department of Orthopaedic Surgery, Massachusetts General Hospital, Yawkey Center, Suite 2100, 55 Fruit Street, Boston, MA, 02114, USA.
出版信息
Clin Orthop Relat Res. 2014 May;472(5):1638-44. doi: 10.1007/s11999-013-3394-8. Epub 2013 Nov 26.
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.
LEVEL OF EVIDENCE
Level IV, prognostic study. See the Instructions for Authors for a complete description of levels of evidence.
背景
Charlson 合并症指数（CCI）最初是为了预测无创伤患者入院后 1 年内的死亡率而开发的。由于它包含与医疗和手术复杂性相关的因素，因此它也可能是预测骨科手术后再次住院的有用工具，但据我们所知，这尚未得到研究。
问题/目的：我们想知道 CCI 评分的增加是否与（1）再入院、（2）手术部位感染或其他不良事件的风险增加、（3）输血风险或（4）骨科手术后的死亡率有关。
方法
分析了 2008 年至 2011 年间进行的 30129 例骨科手术，且在之前的 30 天内没有任何骨科手术。国际疾病分类，第 9 版代码用于确定诊断、手术、与手术相关的不良事件、手术部位感染和 CCI 中列出的合并症。共有 913 例（3.0%）患者在出院后 30 天内再次入院；393 例（1.4%）患者发生不良事件；417 例（1.4%）患者发生手术部位感染；211 例（1.4%）需要输血，56 例（0.2%）患者在手术后 30 天内死亡。使用普通最小二乘法回归分析确定 CCI 是否与这些结果相关。
结果
CCI 解释了再入院差异的 10%。CCI 评分每增加 1 分，关节置换术患者的再入院风险增加 0.45%，创伤手术患者的再入院风险增加 0.63%，脊柱手术患者的再入院风险增加 0.9%（均 p < 0.01）。CCI 与手术部位感染或其他不良事件无关，但占输血率差异的 8%和术后 30 天内死亡率差异的 10%。
结论
CCI 可用于估计关节置换术、手和上肢手术、脊柱手术和创伤手术的再入院风险。它还可用于估计关节置换术、脊柱、创伤和骨肿瘤骨科手术的输血风险，以及肩部、创伤和骨肿瘤骨科手术的死亡率风险。
证据水平
IV 级，预后研究。请参阅作者说明，以获取完整的证据水平描述。
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