髋部骨折手术治疗后不良结局的判别能力：Charlson合并症指数、Elixhauser合并症测量法和改良衰弱指数的比较
Discriminative Ability for Adverse Outcomes After Surgical Management of Hip Fractures: A Comparison of the Charlson Comorbidity Index, Elixhauser Comorbidity Measure, and Modified Frailty Index.
作者信息
Ondeck Nathaniel T, Bovonratwet Patawut, Ibe Izuchukwu K, Bohl Daniel D, McLynn Ryan P, Cui Jonathan J, Baumgaertner Michael R, Grauer Jonathan N
机构信息
Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT.
Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL.
出版信息
J Orthop Trauma. 2018 May;32(5):231-237. doi: 10.1097/BOT.0000000000001140.
OBJECTIVES
The Charlson comorbidity index (CCI), Elixhauser comorbidity measure (ECM), and modified frailty index (mFI) have been associated with mortality after hip fracture. The present study compares the clinically informative discriminative ability of CCI, ECM, and mFI, as well as demographic characteristics for predicting in-hospital adverse outcomes after surgical management of hip fractures.
METHODS
Patients undergoing hip fracture surgery were selected from the 2013 National Inpatient Sample. The discriminative ability of CCI, ECM, and mFI, as well as demographic factors for adverse outcomes were assessed using the area under the curve analysis from receiver operating characteristic curves. Outcomes included the occurrence of any adverse event, death, severe adverse events, minor adverse events, and extended hospital stay.
RESULTS
In total, 49,738 patients were included (mean age: 82 years). In comparison with CCI and mFI, ECM had the significantly largest discriminative ability for the occurrence of all outcomes. Among demographic factors, age had the sole or shared the significantly largest discriminative ability for all adverse outcomes except extended hospital stay. The best performing comorbidity index (ECM) outperformed the best performing demographic factor (age) for all outcomes.
CONCLUSION
Among both comorbidity indices and demographic factors, the ECM had the best overall discriminative ability for adverse outcomes after surgical management of hip fractures. The use of this index in correctly identifying patients at risk for postoperative complications may help set appropriate patient expectations, assist in optimizing prophylaxis regimens for medical management, and adjust reimbursements. More widespread use of this measure for hip fracture studies may be appropriately considered.
LEVEL OF EVIDENCE
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
目的
查尔森合并症指数（CCI）、埃利克斯豪泽合并症衡量指标（ECM）和改良虚弱指数（mFI）均与髋部骨折后的死亡率相关。本研究比较了CCI、ECM和mFI在临床上的信息判别能力，以及预测髋部骨折手术治疗后院内不良结局的人口统计学特征。
方法
从2013年全国住院患者样本中选取接受髋部骨折手术的患者。使用受试者工作特征曲线的曲线下面积分析评估CCI、ECM和mFI的判别能力以及不良结局的人口统计学因素。结局包括任何不良事件的发生、死亡、严重不良事件、轻微不良事件和延长住院时间。
结果
共纳入49738例患者（平均年龄：82岁）。与CCI和mFI相比，ECM对所有结局发生情况的判别能力显著最大。在人口统计学因素中，除延长住院时间外，年龄对所有不良结局具有唯一或显著最大的判别能力。对于所有结局，表现最佳的合并症指数（ECM）优于表现最佳的人口统计学因素（年龄）。
结论
在合并症指数和人口统计学因素中，ECM对髋部骨折手术治疗后的不良结局具有最佳的总体判别能力。使用该指数正确识别有术后并发症风险的患者，可能有助于设定适当的患者预期，协助优化医疗管理的预防方案，并调整报销。可适当考虑在髋部骨折研究中更广泛地使用该指标。
证据水平
预后III级。有关证据水平的完整描述，请参阅作者指南。
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