Anis Hiba K, Sodhi Nipun, Acuña Alexander J, Roth Alexander, Vakharia Rushabh, Newman Jared M, Mufarrih Syed H, Grossman Eric, Roche Martin W, Mont Michael A
Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, Ohio.
Department of Orthopaedic Surgery, Long Island Jewish Medical Center, New Hyde Park, New York.
J Knee Surg. 2021 Oct;34(12):1318-1321. doi: 10.1055/s-0040-1708850. Epub 2020 Apr 8.
A greater number of medically complex patients with multiple comorbidities are now more readily considered for total knee arthroplasty (TKA). Therefore, the purpose of this study was to determine whether comorbidity burden, measured with the Elixhauser Comorbidity Index (ECI), correlated with 90-day medical complications and longer in-hospital lengths-of-stay (LOS) in TKA patients. The PearlDiver supercomputer was queried for all primary TKA patients in the Medicare Standard Analytic Files from 2005 to 2014 using International Classification of Disease, 9th edition codes. Patients were included based on ECI scores, ranging from 1 to 5. ECI 1 patients served as the control cohort, while ECI 2, 3, 4, and 5 patients were considered study cohorts. Each study cohort was matched based on age and gender to the control cohort, resulting in a total of 715,398 patients included for analysis (ECI 1, = 144,072; ECI 2, = 144,072; ECI 3, = 144,072; ECI 4, = 144,072; ECI 5, = 139,110). Logistic regression analyses were performed to compare 90-day medical complications and Welch's -tests were performed to compare LOS between the cohorts. Patients with higher ECI scores were more likely to develop medical complications and have longer LOS compared with matched patients in the control cohort. Compared with matched ECI 1 patients, patients with ECI scores of 2 (odds ratio [OR]: 1.19, 95% confidence interval [CI]: 1.14-1.24), 3 (OR: 1.27, 95% CI: 1.21-1.32), 4 (OR: 1.32, 95% CI: 1.27-1.38), and 5 (OR: 1.33, 95% CI: 1.27-1.39) were significantly more likely to develop 90-day medical complications. Additionally, the mean LOS of patients in the ECI 2 (2.59 ± 1.49 vs. 2.73 ± 1.52 days), ECI 3 (2.59 ± 1.49 vs. 2.88 ± 1.51 days; < 0.001), ECI 4 (2.59 ± 1.49 vs. 3.01 ± 1.56 days; < 0.001), and ECI 5 (2.61 ± 1.49 vs. 3.14 ± 1.61 days; < 0.001) groups were significantly longer than the mean LOS in the control ECI 1 group. In an increasingly complex patient population, associations between comorbidities and outcomes after TKA procedures can guide providers on how to modify their pre- and postoperative care. These results demonstrate that higher ECI scores are associated with a greater likelihood of 90-day medical complications and longer in-hospital LOS.
现在，越来越多患有多种合并症的病情复杂的患者更容易被考虑进行全膝关节置换术（TKA）。因此，本研究的目的是确定用艾利克斯豪泽合并症指数（ECI）衡量的合并症负担是否与TKA患者90天的医疗并发症以及更长的住院时间（LOS）相关。使用国际疾病分类第九版编码，在PearlDiver超级计算机上查询了2005年至2014年医疗保险标准分析文件中的所有初次TKA患者。根据ECI评分（范围为1至5）纳入患者。ECI 1的患者作为对照队列，而ECI 2、3、4和5的患者被视为研究队列。每个研究队列根据年龄和性别与对照队列进行匹配，共有715,398名患者纳入分析（ECI 1 = 144,072；ECI 2 = 144,072；ECI 3 = 144,072；ECI 4 = 144,072；ECI 5 = 139,110）。进行逻辑回归分析以比较90天的医疗并发症，并进行韦尔奇检验以比较各队列之间的住院时间。与对照队列中匹配的患者相比，ECI评分较高的患者更有可能发生医疗并发症且住院时间更长。与匹配的ECI 1患者相比，ECI评分为2（比值比[OR]：1.19，95%置信区间[CI]：1.14 - 1.24）、3（OR：1.27，95% CI：1.21 - 1.32）、4（OR：1.32，95% CI：1.27 - 1.38）和5（OR：1.33，95% CI：1.27 - 1.39）的患者发生90天医疗并发症的可能性显著更高。此外，ECI 2组（2.59±1.49天对2.73±1.52天）、ECI 3组（2.59±1.49天对2.88±1.51天；P < 0.001）、ECI 4组（2.59±1.49天对3.01±1.56天；P < 0.001）和ECI 5组（2.61±
