Sports Medicine Institute, Hospital for Special Surgery, New York, USA.
Department of Population Health Sciences, Weill Cornell Medical College, New York, USA.
Bone Joint J. 2021 May;103-B(5):964-970. doi: 10.1302/0301-620X.103B5.BJJ-2020-1503.R1.
To investigate the impact of the Charlson and Elixhauser comorbidity indices on patient-reported outcomes measures (PROMs) following shoulder arthroplasty.
Patients undergoing total shoulder arthroplasty (TSA), reverse shoulder arthroplasty (RSA), or hemiarthroplasty (HA) from 2016 to 2018 were identified, along with the Charlson and Elixhauser comorbidities listed as their secondary diagnoses in the electronic medical records. Patients were matched to our institution's registry to obtain their PROMs, including shoulder-specific (American Shoulder and Elbow Society (ASES) and Shoulder Activity Scale (SAS)) and general health scales (12-Item Short Form Survey (SF-12) and Patient-Reported Outcomes Measurement Information System-Pain Interference). Linear regression models adjusting for age and sex were used to evaluate the association between increasing number of comorbidities and PROM scores. A total of 1,817 shoulder arthroplasties were performed: 1,017 (56%) TSA, 726 (40%) RSA, and 74 (4%) HA. The mean age was 67 years (SD 10), and 936 (52%) of the patients were female.
The most common comorbidities were obesity (1,256, 69%) and hypertension (990, 55%). Patients with more comorbidities had lower ASES and SAS scores at baseline (p < 0.001). Elixhauser comorbidities continued to negatively impact ASES and SAS scores at one year (p = 0.002) and two-year follow-up (p = 0.002). Patients with more comorbidities reported greater pain interference on PROMIS at baseline (p = 0.007), but not at two years. Higher number of Charlson comorbidities were associated with lower scores on the SF-12 mental component at baseline (p < 0.001) and two years (p = 0.020). Higher number of Elixhauser comorbidities were associated with lower SF-12 physical component scores at baseline (p < 0.001) and two years (p = 0.004).
Higher number of comorbidities was associated with lower baseline scores and worse outcomes on both shoulder-specific and general health PROMs. The presence of specific comorbidities may be used during shared decision-making to manage expectations for patients undergoing shoulder arthroplasty. Cite this article: 2021;103-B(5):964-970.
探讨 Charlson 和 Elixhauser 合并症指数对肩关节置换术后患者报告结局测量（PROMs）的影响。
从 2016 年至 2018 年，确定接受全肩关节置换术（TSA）、反肩关节置换术（RSA）或半肩关节置换术（HA）的患者，并在电子病历中将 Charlson 和 Elixhauser 合并症列为次要诊断。患者与我院的登记处相匹配，以获取他们的 PROMs，包括肩部特异性（美国肩肘外科协会（ASES）和肩部活动量表（SAS））和一般健康量表（12 项简短表格调查（SF-12）和患者报告结果测量信息系统疼痛干扰）。使用调整年龄和性别的线性回归模型来评估合并症数量增加与 PROM 评分之间的关联。共进行了 1817 例肩关节置换术：1017 例（56%）TSA、726 例（40%）RSA 和 74 例（4%）HA。平均年龄为 67 岁（标准差 10），936 例（52%）为女性。
最常见的合并症是肥胖症（1256 例，69%）和高血压（990 例，55%）。合并症较多的患者在基线时的 ASES 和 SAS 评分较低（p <0.001）。Elixhauser 合并症在一年（p=0.002）和两年随访时（p=0.002）仍继续对 ASES 和 SAS 评分产生负面影响。合并症较多的患者在 PROMIS 基线时报告疼痛干扰更大（p=0.007），但两年时没有。Charlson 合并症数量较高与 SF-12 心理成分的基线（p<0.001）和两年（p=0.020）评分较低相关。Elixhauser 合并症数量较高与 SF-12 生理成分的基线（p<0.001）和两年（p=0.004）评分较低相关。
合并症数量较多与肩部特异性和一般健康 PROMs 的基线评分较低和结局较差相关。特定合并症的存在可在进行肩关节置换术的患者的共同决策中用于管理预期。
