All of the authors declare non-financial competing interests.
MCSI: Worked on the conception and designed the study, conducted the data analysis, conducted the interpretation of the results, and drafted and finalized the manuscript. NLP: Worked on the conception of the study, acquired data for the study, assisted with the data analysis and interpretations of the results, and provided critical review of the manuscript. EER: Worked on the conception of the study, acquired data for the study, assisted with the interpretations of the results, and provided critical review of the manuscript. SEG: Worked on the conception of the study, assisted with the interpretations of the results, and provided critical review of the manuscript. All authors read and approved the final manuscript and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Joint arthroplasty patients have a high prevalence of co-morbidities and this impacts their surgical outcomes. There are different ways to ascertain co-morbidities and appropriate measurement is necessary. The purpose of this study was to: (1) describe the prevalence of co-morbidities in a cohort of total hip arthroplasty (THA) and knee arthroplasty (TKA) patients using two diagnoses-based measures (Charlson and Elixhauser) and one prescription-based measure (RxRisk-V); (2) compare the agreement of co-morbidities amongst the measures.
A cross-sectional study of Australian veterans undergoing THAs (n = 11,848) and TKAs (n = 18,972) between 2001 and 2012 was conducted. Seventeen co-morbidities were identified using the Charlson, 30 using the Elixhauser, and 42 using the RxRisk-V measure. Agreement between co-morbidities was calculated using Kappa (κ) statistics.
Combining measures, 64 conditions were identified, of these 28 were only identified using the RxRisk-V, 11 using the Elixhauser, and 2 using the Charlson. The most prevalent conditions was pain treated with anti-inflammatories (58.7 % THAs, 55.9 % TKAs), pain treated with narcotics (55.0 % THAs, 50.9 % TKAs), hypertension (56.0 % THAs and TKAs), and anticoagulation disorders (53.0 % THAs, 48.6 % TKAs). Diabetes was the only condition with substantial agreement (all κ > 0.6) amongst all measures. When comparing the diagnoses based algorithms, agreement was high for overlapping conditions (all κ > 0.71).
Different measures identified different co-morbidities, provided different estimates for the same co-morbidity, and had different levels of agreement for common co-morbidities. This highlights the importance of understanding co-morbidity measures and using them appropriately in studies and case-mix adjustments analyses.
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- Comparing co-morbidities in total joint arthroplasty patients using the RxRisk-V, Elixhauser, and Charlson Measures: a cross-sectional evaluation
Maria C. S. Inacio
Nicole L. Pratt
Elizabeth E. Roughead
Stephen E. Graves
- BioMed Central
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