Relationship Between Comorbidity Burden and Short-Term Outcomes Across 4680 Consecutive Spinal Fusions
Copyright © 2023 Elsevier Inc. All rights reserved..
OBJECTIVE: Preoperative management requires the identification and optimization of modifiable medical comorbidities, though few studies isolate comorbid status from related patient-level variables. This study evaluates Charlson Comorbidity Index (CCI)-an easily derived measure of aggregate medical comorbidity-to predict outcomes from spinal fusion surgery. Coarsened exact matching is employed to control for key patient characteristics and isolate CCI.
METHODS: We retrospectively assessed 4680 consecutive patients undergoing single-level, posterior-only lumbar fusion at a single academic center. Logistic regression evaluated the univariate relationship between CCI and patient outcomes. Coarsened exact matching generated exact demographic matches between patients with high comorbid status (CCI >6) or no medical comorbidities (matched n = 524). Patients were matched 1:1 on factors associated with surgical outcomes, and outcomes were compared between matched cohorts. Primary outcomes included surgical complications, discharge status, 30- and 90-day risk of readmission, emergency department (ED) visits, reoperation, and mortality.
RESULTS: Univariate regression of increasing CCI was significantly associated with non-home discharge, as well as 30- and 90-day readmission, ED visits, and mortality (all P < 0.05). Subsequent isolation of comorbidity between otherwise exact-matched cohorts found comorbid status did not affect readmissions, reoperations, or mortality; high CCI score was significantly associated with non-home discharge (OR = 2.50, P < 0.001) and 30-day (OR = 2.44, P = 0.02) and 90-day (OR = 2.29, P = 0.008) ED evaluation.
CONCLUSIONS: Comorbidity, measured by CCI, did not increase the risk of readmission, reoperation, or mortality. Single-level, posterior lumbar fusions may be safe in appropriately selected patients regardless of comorbid status. Future studies should determine whether CCI can guide discharge planning and postoperative optimization.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:180 |
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| Enthalten in: |
World neurosurgery - 180(2023) vom: 19. Dez., Seite e84-e90 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Wathen, Connor A [VerfasserIn] |
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| Links: |
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| Themen: |
Coarsened exact matching |
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| Anmerkungen: |
Date Completed 21.12.2023 Date Revised 21.12.2023 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1016/j.wneu.2023.08.044 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM360964214 |
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| 100 | 1 | |a Wathen, Connor A |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Relationship Between Comorbidity Burden and Short-Term Outcomes Across 4680 Consecutive Spinal Fusions |
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| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2023 Elsevier Inc. All rights reserved. | ||
| 520 | |a OBJECTIVE: Preoperative management requires the identification and optimization of modifiable medical comorbidities, though few studies isolate comorbid status from related patient-level variables. This study evaluates Charlson Comorbidity Index (CCI)-an easily derived measure of aggregate medical comorbidity-to predict outcomes from spinal fusion surgery. Coarsened exact matching is employed to control for key patient characteristics and isolate CCI | ||
| 520 | |a METHODS: We retrospectively assessed 4680 consecutive patients undergoing single-level, posterior-only lumbar fusion at a single academic center. Logistic regression evaluated the univariate relationship between CCI and patient outcomes. Coarsened exact matching generated exact demographic matches between patients with high comorbid status (CCI >6) or no medical comorbidities (matched n = 524). Patients were matched 1:1 on factors associated with surgical outcomes, and outcomes were compared between matched cohorts. Primary outcomes included surgical complications, discharge status, 30- and 90-day risk of readmission, emergency department (ED) visits, reoperation, and mortality | ||
| 520 | |a RESULTS: Univariate regression of increasing CCI was significantly associated with non-home discharge, as well as 30- and 90-day readmission, ED visits, and mortality (all P < 0.05). Subsequent isolation of comorbidity between otherwise exact-matched cohorts found comorbid status did not affect readmissions, reoperations, or mortality; high CCI score was significantly associated with non-home discharge (OR = 2.50, P < 0.001) and 30-day (OR = 2.44, P = 0.02) and 90-day (OR = 2.29, P = 0.008) ED evaluation | ||
| 520 | |a CONCLUSIONS: Comorbidity, measured by CCI, did not increase the risk of readmission, reoperation, or mortality. Single-level, posterior lumbar fusions may be safe in appropriately selected patients regardless of comorbid status. Future studies should determine whether CCI can guide discharge planning and postoperative optimization | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Coarsened exact matching | |
| 650 | 4 | |a Lumbar fusion | |
| 650 | 4 | |a Medical comorbidity | |
| 650 | 4 | |a Spine surgery | |
| 700 | 1 | |a Gallagher, Ryan S |e verfasserin |4 aut | |
| 700 | 1 | |a Borja, Austin J |e verfasserin |4 aut | |
| 700 | 1 | |a Malhotra, Emelia G |e verfasserin |4 aut | |
| 700 | 1 | |a Collier, Tara |e verfasserin |4 aut | |
| 700 | 1 | |a Na, Jianbo |e verfasserin |4 aut | |
| 700 | 1 | |a McClintock, Scott D |e verfasserin |4 aut | |
| 700 | 1 | |a Yoon, Jang W |e verfasserin |4 aut | |
| 700 | 1 | |a Ozturk, Ali K |e verfasserin |4 aut | |
| 700 | 1 | |a Schuster, James M |e verfasserin |4 aut | |
| 700 | 1 | |a Welch, William C |e verfasserin |4 aut | |
| 700 | 1 | |a Marcotte, Paul J |e verfasserin |4 aut | |
| 700 | 1 | |a Malhotra, Neil R |e verfasserin |4 aut | |
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