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Low predictive power of comorbidity indices identified for mortality after acute arthroplasty surgery undertaken for femoral neck fracture

Bülow, E. LU ; Cnudde, P.; Rogmark, C. LU ; Rolfson, O. and Nemes, S. (2019) In Bone and Joint Journal 101B(1). p.104-112
Abstract

Aims Our aim was to examine the Elixhauser and Charlson comorbidity indices, based on administrative data available before surgery, and to establish their predictive value for mortality for patients who underwent hip arthroplasty in the management of a femoral neck fracture. Patients and Methods We analyzed data from 42 354 patients from the Swedish Hip Arthroplasty Register between 2005 and 2012. Only the first operated hip was included for patients with bilateral arthroplasty. We obtained comorbidity data by linkage from the Swedish National Patient Register, as well as death dates from the national population register. We used univariable Cox regression models to predict mortality based on the comorbidity indices, as well as... (More)

Aims Our aim was to examine the Elixhauser and Charlson comorbidity indices, based on administrative data available before surgery, and to establish their predictive value for mortality for patients who underwent hip arthroplasty in the management of a femoral neck fracture. Patients and Methods We analyzed data from 42 354 patients from the Swedish Hip Arthroplasty Register between 2005 and 2012. Only the first operated hip was included for patients with bilateral arthroplasty. We obtained comorbidity data by linkage from the Swedish National Patient Register, as well as death dates from the national population register. We used univariable Cox regression models to predict mortality based on the comorbidity indices, as well as multivariable regression with age and gender. Predictive power was evaluated by a concordance index, ranging from 0.5 to 1 (with the higher value being the better predictive power). A concordance index less than 0.7 was considered poor. We used bootstrapping for internal validation of the results. Results The predictive power of mortality was poor for both the Elixhauser and Charlson comorbidity indices (concordance indices less than 0.7). The Charlson Comorbidity Index was superior to Elixhauser, and a model with age and gender was superior to both indices. Conclusion Preoperative comorbidity from administrative data did not predict mortality for patients with a hip fracture treated by arthroplasty. This was true even if association on group level existed.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Bone and Joint Journal
volume
101B
issue
1
pages
9 pages
publisher
British Editorial Society of Bone & Joint Surgery
external identifiers
  • scopus:85059403898
ISSN
2049-4394
DOI
10.1302/0301-620X.101B1.BJJ-2018-0894.R1
language
English
LU publication?
yes
id
a56953c1-dff8-46da-92a4-4090581bfe7e
date added to LUP
2019-01-11 09:38:08
date last changed
2019-02-20 11:42:38
@article{a56953c1-dff8-46da-92a4-4090581bfe7e,
  abstract     = {<p>Aims Our aim was to examine the Elixhauser and Charlson comorbidity indices, based on administrative data available before surgery, and to establish their predictive value for mortality for patients who underwent hip arthroplasty in the management of a femoral neck fracture. Patients and Methods We analyzed data from 42 354 patients from the Swedish Hip Arthroplasty Register between 2005 and 2012. Only the first operated hip was included for patients with bilateral arthroplasty. We obtained comorbidity data by linkage from the Swedish National Patient Register, as well as death dates from the national population register. We used univariable Cox regression models to predict mortality based on the comorbidity indices, as well as multivariable regression with age and gender. Predictive power was evaluated by a concordance index, ranging from 0.5 to 1 (with the higher value being the better predictive power). A concordance index less than 0.7 was considered poor. We used bootstrapping for internal validation of the results. Results The predictive power of mortality was poor for both the Elixhauser and Charlson comorbidity indices (concordance indices less than 0.7). The Charlson Comorbidity Index was superior to Elixhauser, and a model with age and gender was superior to both indices. Conclusion Preoperative comorbidity from administrative data did not predict mortality for patients with a hip fracture treated by arthroplasty. This was true even if association on group level existed.</p>},
  author       = {Bülow, E. and Cnudde, P. and Rogmark, C. and Rolfson, O. and Nemes, S.},
  issn         = {2049-4394},
  language     = {eng},
  number       = {1},
  pages        = {104--112},
  publisher    = {British Editorial Society of Bone & Joint Surgery},
  series       = {Bone and Joint Journal},
  title        = {Low predictive power of comorbidity indices identified for mortality after acute arthroplasty surgery undertaken for femoral neck fracture},
  url          = {http://dx.doi.org/10.1302/0301-620X.101B1.BJJ-2018-0894.R1},
  volume       = {101B},
  year         = {2019},
}