ArticleArchives of orthopaedic and trauma surgery2023
Can extant comorbidity indices identify patients who experience poor outcomes following total joint arthroplasty?
Article in Archives of orthopaedic and trauma surgery, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers, 1 of them a synthesis that pooled it.
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Who cites it
13 citing papers in PubMed, 1 synthesis or guideline pooled it, 16 citations in OpenAlex.
- Preoperative pathways in adults with multiple long-term conditions undergoing major surgery: a systematic review.BMJ open · 2026Pooled it
- Advancing preoperative planning technology in total joint arthroplasty with a real-time machine learning calculator: 1-year mortality risk in a value-based care era.Arthroplasty (London, England) · 2026Article
- Frailty and Sarcopenia as Predictors of Functional Recovery After Total Hip and Knee Arthroplasty: A Narrative Review.Journal of clinical medicine · 2026Review
- Current comorbidity indices inadequately identify patients who experience early adverse outcomes following total shoulder arthroplasty.Clinics in shoulder and elbow · 2025Article
- Does weightbearing status impact mortality and other complications in hip fracture patients when accounting for frailty?Bone & joint open · 2025Article
- New Perspectives on Risk Assessment and Anticoagulation in Elective Spine Surgery Patients: The Impact of Ultra-Minimally Invasive Endoscopic Surgery Techniques on Patients with Cardiac Disease.Journal of personalized medicine · 2024Article
- MRI use leading up to total knee arthroplasty: a retrospective cohort study.European journal of orthopaedic surgery & traumatology : orthopedie traumatologie · 2024Article
- The risk analysis of perioperative complications of cementless hip arthroplasty in octogenarians.Archives of orthopaedic and trauma surgery · 2023Article
- Crosswalk between Charlson Comorbidity Index and the American Society of Anesthesiologists Physical Status Score for Geriatric Trauma Assessment.Healthcare (Basel, Switzerland) · 2023Article
- An anatomo-functional implant positioning technique with robotic assistance for primary TKA allows the restoration of the native knee alignment and a natural functional ligament pattern, with a faster recovery at 6 months compared to an adjusted mechanical technique.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2023Article
- Risk Analysis Index and Its Recalibrated Version Predict Postoperative Outcomes Better Than 5-Factor Modified Frailty Index in Traumatic Spinal Injury.Neurospine · 2022Article
- No difference in patient-reported satisfaction after 12 months between customised individually made and off-the-shelf total knee arthroplasty.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2022Article
- A systematic review of predictive accuracy via c-statistic of preoperative frailty tests for extended length of stay, post-operative complications, and mortality.Saudi journal of anaesthesiaReview
Corrections and comments
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Authors and funding
6 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionIt is uncertain if generic comorbidity indices commonly used in orthopedics accurately predict outcomes after total hip (THA) or knee arthroplasty (TKA). The purpose of this study was to determine the predictive ability of such comorbidity indices for: (1) 30-day mortality; (2) 30-day rate of major and minor complications; (3) discharge disposition; and (4) extended length of stay (LOS).
methodsThe American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was retrospectively reviewed for all patients who underwent elective THA (n = 202,488) or TKA (n = 230,823) from 2011 to 2019. The American Society of Anesthesiologists (ASA) physical status classification system score, modified Charlson Comorbidity Index (mCCI), Elixhauser Comorbidity Measure (ECM), and 5-Factor Modified Frailty Index (mFI-5) were calculated for each patient. Logistic regression models predicting 30-day mortality, discharge disposition, LOS greater than 1 day, and 30-day major and minor complications were fit for each index.
resultsThe ASA classification (C-statistic = 0.773 for THA and TKA) and mCCI (THA: c-statistic = 0.781; TKA: C-statistic = 0.771) were good models for predicting 30-day mortality. However, ASA and mCCI were not predictive of major and minor complications, discharge disposition, or LOS. The ECM and mFI-5 did not reliably predict any outcomes of interest.
conclusionASA and mCCI are good models for predicting 30-day mortality after THA and TKA. However, similar to ECM and mFI-5, these generic comorbidity risk-assessment tools do not adequately predict 30-day postoperative outcomes or in-hospital metrics. This highlights the need for an updated, data-driven approach for standardized comorbidity reporting and risk assessment in arthroplasty.
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