Lavelle Elizabeth A Demers, Cheney Robert, Lavelle William F
SUNY Upstate Medical University, Syracuse, NY.
Albany Medical Center, Albany, NY.
Int J Spine Surg. 2015 Nov 12;9:63. doi: 10.14444/2063. eCollection 2015.
Morbidity and mortality scores are useful to control for medical comorbidities in study populations where either effects of an illness or benefits of a treatment are examined. Our study examined if a direct relationship existed between the American Society of Anesthesiologists Physical Status (ASA) score and the Charlson Comorbidity Index (CCI) in an osteoporosis population where patients had sustained a vertebral compression fracture.
A retrospective chart review of patients with osteoporotic compression fractures treated by the same orthopedic surgeon between June 2000 and June 2004 was performed. The primary endpoint was death by the close of the study period (September 2006). A board certified Anesthesiologist blindly assigned all of the ASA scores as well as the Charlson Scores independently in a blinded manner. All patients were assumed to be undergoing surgery as they were assigned. A statistical relationship was examined between ASA and CCI scores through a cross table analysis with chi-squared testing as both scoring systems were considered categorical. A Pearson correlation was completed to examine the quality of a linear relationship between the categorical variable ASA compared to the continuous variable Charlson. A value of p < 0.05 was considered significant.
Ninety patients elected conservative therapy with oral analgesics and an orthosis, while 94 patients elected for kyphoplasty. The CCI by log rank testing was not significant (p= 0.2027) for the surgery population; however, the test resulted in a highly significant value (p = 0.0161) in non-operative population. The ASA Score was correlated with significance to mortality (p= 0.0150) for the surgery population, while the test was not significant (p = 0.1439) in non-operative population. Treating both ASA and CCI scores as categorical variables, a relationship between them was examined and found to be highly significant (p= 0.000001) meaning patients with low ASA scores were likely to have low CCI scores.
The ASA score was predictive of mortality in a surgical population, while CCI was highly predictive of mortality in a non-surgical population. There is great agreement between the CCI score and the ASA score, reflecting that anesthesiologists subjectively consider the same elements of the patient's medical history when assigning ASA scores as the CCI objectively uses. This was a Level III Study.
在研究某种疾病的影响或某种治疗的益处的研究人群中，发病率和死亡率评分有助于控制合并症。我们的研究探讨了在美国麻醉医师协会身体状况（ASA）评分与Charlson合并症指数（CCI）之间是否存在直接关系，研究对象为患有椎体压缩性骨折的骨质疏松症患者。
对2000年6月至2004年6月间由同一位骨科医生治疗的骨质疏松性压缩骨折患者进行回顾性病历审查。主要终点是研究期结束时（2006年9月）的死亡情况。一名获得委员会认证的麻醉医师以盲法独立分配所有的ASA评分以及Charlson评分。所有患者在被分配时均假定正在接受手术。通过交叉表分析和卡方检验来研究ASA和CCI评分之间的统计关系，因为这两种评分系统都被视为分类变量。完成Pearson相关性分析以检验分类变量ASA与连续变量Charlson之间线性关系的质量。p值<0.05被认为具有统计学意义。
90例患者选择口服镇痛药和矫形器的保守治疗，而94例患者选择椎体成形术。对于手术人群，通过对数秩检验得出的CCI无统计学意义（p = 0.2027）；然而，该检验在非手术人群中得出了高度显著的值（p = 0.0161）。对于手术人群，ASA评分与死亡率具有显著相关性（p = 0.0150），而该检验在非手术人群中无统计学意义（p = 0.1439）。将ASA和CCI评分都视为分类变量，对它们之间的关系进行研究并发现具有高度显著性（p = 0.000001），这意味着ASA评分低的患者CCI评分可能也低。
ASA评分可预测手术人群的死亡率，而CCI可高度预测非手术人群的死亡率。CCI评分与ASA评分之间具有高度一致性，这反映出麻醉医师在分配ASA评分时主观考虑的患者病史要素与CCI客观使用的要素相同。这是一项III级研究。
