1
|
Teves J, Holc F, Castro Lalín A, García-Mansilla A, Vildoza S, R B, Carbó L, Costantini J. Are frailty scores superior to the ASA score in predicting complications, hospital stay, and readmissions in total knee replacement? A comparative study between octogenarian and septuagenarian patients. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024; 68:128-133. [PMID: 37263578 DOI: 10.1016/j.recot.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 04/23/2023] [Accepted: 05/11/2023] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Frailty scores have not been standardized for the preoperative assessment of patients undergoing total knee replacement (TKR). The aim of this study was to compare the efficacy of the American Society of Anesthesiology (ASA) score, the Charlson comorbidity index (ICC) and the simple frailty score (SSF) in predicting complications, hospital stay, readmissions and mortality after elective TKR. MATERIALS AND METHODS We retrospectively studied 448 patients who underwent TKR for osteoarthritis at our institution between 2016 and 2019. They were divided into two groups: Group A (263 patients, <80 years) and Group B (185 patients, >80 years).). All were classified by ASA, ICC and SSF scores. RESULTS The ICC was higher in Group B (median 5 [RI: 4-6] vs. 4 [RI: 3-5]; P<.001); however, it was not associated with a higher number of complications. When performing a logistic regression analysis we found, for complications: OR SSF=0.67, ICC=1.11; ASA 3 & 4=0.89 and age=1.04; while for readmissions: OR SSF=2.09; ICC=1.01; ASA 3 & 4=0.79 and age=1. CONCLUSIONS The ICC and SSF scales showed no differences to the ASA scale in the prediction of readmissions, complications and hospital stay. However, the SSF seems to have a better correlation in predicting unplanned readmission.
Collapse
Affiliation(s)
- J Teves
- Departamento de Ortopedia, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
| | - F Holc
- Departamento de Ortopedia, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - A Castro Lalín
- Departamento de Anestesiología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - A García-Mansilla
- Departamento de Ortopedia, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - S Vildoza
- Departamento de Ortopedia, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Brandariz R
- Departamento de Ortopedia, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - L Carbó
- Departamento de Ortopedia, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - J Costantini
- Departamento de Ortopedia, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| |
Collapse
|
2
|
Teves J, Holc F, Castro Lalín A, García-Mansilla A, Vildoza S, Brandariz R, Carbó L, Costantini J. [Translated article] Are frailty scores superior to the ASA score in predicting complications, hospital stay, and readmissions in total knee replacement? A comparative study between octogenarian and septuagenarian patients. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024; 68:T128-T133. [PMID: 38000542 DOI: 10.1016/j.recot.2023.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 05/11/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Frailty scores have not been standardised for the preoperative assessment of patients undergoing total knee replacement (TKR). The aim of this study was to compare the efficacy of the American Society of Anesthesiology (ASA) score, the Charlson comorbidity index (ICC) and the simple frailty score (SSF) in predicting complications, hospital stay, readmissions and mortality after elective TKR. MATERIALS AND METHODS We retrospectively studied 448 patients who underwent TKR for osteoarthritis at our institution between 2016 and 2019. They were divided into two groups: Group A (263 patients, <80 years) and Group B (185 patients, >80 years).). All were classified by ASA, ICC and SSF scores. RESULTS The ICC was higher in Group B (median 5 [RI: 4-6] vs. 4 [RI: 3-5]; p<.001); however, it was not associated with a higher number of complications. When performing a logistic regression analysis we found, for complications: OR SSF=0.67; ICC=1.11; ASA 3 & 4=0.89 and age=1.04; while for readmissions: OR SSF=2.09; ICC=1.01; ASA 3 & 4=0.79 and age=1. CONCLUSIONS The ICC and SSF scales showed no differences to the ASA scale in the prediction of readmissions, complications and hospital stay. However, the SSF seems to have a better correlation in predicting unplanned readmission.
Collapse
Affiliation(s)
- J Teves
- Departamento de Ortopedia, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
| | - F Holc
- Departamento de Ortopedia, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - A Castro Lalín
- Departamento de Anestesiología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - A García-Mansilla
- Departamento de Ortopedia, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - S Vildoza
- Departamento de Ortopedia, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - R Brandariz
- Departamento de Ortopedia, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - L Carbó
- Departamento de Ortopedia, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - J Costantini
- Departamento de Ortopedia, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| |
Collapse
|
3
|
González-Castillo AM, Sancho-Insenser J, Miguel-Palacio MD, Morera-Casaponsa JR, Membrilla-Fernández E, Pons-Fragero MJ, Grande-Posa L, Pera-Román M. Risk factors for complications in acute calculous cholecystitis. Deconstruction of the Tokyo Guidelines. Cir Esp 2023; 101:170-179. [PMID: 36108956 DOI: 10.1016/j.cireng.2022.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 02/12/2022] [Indexed: 12/07/2022]
Abstract
OBJECTIVE To challenge the risk factors described in Tokyo Guidelines in Acute Calculous Cholecystitis. METHODS Retrospective single center cohort study with 963 patients with Acute Cholecystitis during a period of 5 years. Some 725 patients with a "pure" Acute Calculous Cholecystitis were selected. The analysis included 166 variables encompassing all risk factors described in Tokyo Guidelines. The Propensity Score Matching method selected two subgroups of patients with equal comorbidities, to compare the severe complications rate according to the initial treatment (Surgical vs Non-Surgical). We analyzed the Failure-to-rescue as a quality indicator in the treatment of Acute Calculous Cholecystitis. RESULTS the median age was 69 years (IQR 53-80). 85.1% of the patients were ASA II or III. The grade of the Acute Calculous Cholecystitis was mild in a 21%, moderate in 39% and severe in 40% of the patients. Cholecystectomy was performed in 95% of the patients. The overall complications rate was 43% and the mortality was 3.6%. The Logistic Regression model isolated 3 risk factor for severe complication: ASA > II, cancer without metastases and moderate to severe renal disease. The Failure-to-Rescue (8%) was higher in patients with non-surgical treatment (32% vs. 7%; P = 0.002). After Propensity Score Matching, the number of severe complications was similar between Surgical and Non-Surgical treatment groups (48.5% vs 62.5%; P = 0.21). CONCLUSIONS the recommended treatment for Acute Calculous Cholecystitis is the Laparoscopic Cholecystectomy. Only three risk factors from the Tokyo Guidelines list appeared as independent predictors of severe complications. The failure-to-rescue is higher in non-surgically treated patients.
Collapse
Affiliation(s)
- Ana María González-Castillo
- Departamento de Cirugía, Universidad Autónoma de Barcelona, Barcelona, Spain; Unidad de Cirugía de Urgencias, Sección de Cirugía General, Servicio de Cirugía General y Digestiva, Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM).
| | - Juan Sancho-Insenser
- Departamento de Cirugía, Universidad Autónoma de Barcelona, Barcelona, Spain; Unidad de Cirugía de Urgencias, Sección de Cirugía General, Servicio de Cirugía General y Digestiva, Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM)
| | - Maite De Miguel-Palacio
- Departamento de Cirugía, Universidad Autónoma de Barcelona, Barcelona, Spain; Unidad de Cirugía de Urgencias, Sección de Cirugía General, Servicio de Cirugía General y Digestiva, Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM)
| | | | - Estela Membrilla-Fernández
- Departamento de Cirugía, Universidad Autónoma de Barcelona, Barcelona, Spain; Unidad de Cirugía de Urgencias, Sección de Cirugía General, Servicio de Cirugía General y Digestiva, Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM)
| | - María-José Pons-Fragero
- Unidad de Cirugía de Urgencias, Sección de Cirugía General, Servicio de Cirugía General y Digestiva, Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM)
| | - Luis Grande-Posa
- Departamento de Cirugía, Universidad Autónoma de Barcelona, Barcelona, Spain; Unidad de Cirugía de Urgencias, Sección de Cirugía General, Servicio de Cirugía General y Digestiva, Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM)
| | - Miguel Pera-Román
- Departamento de Cirugía, Universidad Autónoma de Barcelona, Barcelona, Spain; Unidad de Cirugía de Urgencias, Sección de Cirugía General, Servicio de Cirugía General y Digestiva, Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM)
| |
Collapse
|
4
|
Fernández Bermejo LA, Gutiérrez Ortega C, Jareño Esteban JJ. Prognostic value of the Charlson index in mortality in patients with pulmonary embolism associated with cancer versus non-tumour pulmonary embolism. Med Clin (Barc) 2021; 158:201-205. [PMID: 33836857 DOI: 10.1016/j.medcli.2021.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 02/10/2021] [Accepted: 02/16/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The aim of this study is to analyse comorbidity, survival, and mortality from pulmonary embolism (PE) in people with cancer and without cancer. And to determine whether the Charlson Comorbidity Index (CCI) predicts mortality in the short and long term in this population. METHODS A retrospective observational study on survival in patients hospitalized in the Hospital Central de la Defensa from 1-01-2009 to 15-03-2018, stratifying into tumour PE group (EPT) and non-tumour PE group (EPnT), all of whom were classified according to age adjusted CCI. RESULTS A total of 368 patients were diagnosed with PE, 108 with associated cancer. The mean CCI in the EPT group was 7.2 and 4.5 in the EPnT group. Patients with PE and CCI>5 were 10.7 times more likely to die (95%CI 1.5-77.6) compared to CCI 0 (P=.019). The CCI of patients with EPT was 2.6 points higher (95%CI 1.9-33) than EPnT patients (P<.001). Cancer patients were 1.9 times more likely to die (95%CI 1.23-2.8) and had higher mortality at 30 days and at one year after the event, with a median survival of 8.98 years and 3.4 years, respectively (P<.001). CONCLUSIONS The CCI in EPT is an independent risk factor related to mortality. The CCI can predict higher mortality in the short and long term in patients with PE.
Collapse
|
5
|
García-Cruz E, Carrión A, Ajami T, Álvarez M, Correas MÁ, García B, García JV, González C, Portillo JA, Romero-Otero J, Simón C, Torremadé J, Vigués F, Alcaraz A. The Patient's Comorbidity Burden Correlates with the Erectile Dysfunction Severity. Actas Urol Esp 2018. [PMID: 28641871 DOI: 10.1016/j.acuro.2017.03.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To explore the potential relationship between erectile dysfunction (ED), low testosterone levels, and the Charlson Comorbidity Index (CCI). MATERIAL AND METHODS Cross-sectional study on patients referred to the andrology unit in 7 Spanish centers. The ED was diagnosed and graded using the International Index of Erectile Function (IIEF-5) score. Total testosterone, the prevalence of each comorbidity, and the CCI were compared between patients with different grades of ED. Besides, the correlation between total testosterone and the CCI score, the influence of each comorbidity, and the ED severity on the CCI was assessed in a multiple linear regression. RESULTS The study included 430 men with a mean age of 61 years. The mean CCI was 3.5, and mean total testosterone 15.2 nmol/L; 389 (91%) subjects had some grade of ED: 97 (23%) mild, 149 (35%) mild-to-moderate, 86 (20%) moderate, and 57 (13%) severe. The increase in ED severity was significantly associated with a decrease in total testosterone (P=.002), and an increase in the CCI score (P<.001). Testosterone levels were significantly lower in patients with obesity, diabetes, hypercholesterolemia, and hypertriglyceridemia (P<.05). However, only the prevalence of diabetes and hypertension was significantly associated with the severity of ED. The multivariate analysis including variables related to all assessed comorbidities, total testosterone levels, and the DE severity significantly predicted the CCI score (P<.001, R2=.426). The severity of ED significantly contributed to this model (P=.011), but total testosterone did not (P=.204). CONCLUSIONS The CCI is significantly associated with the ED severity, but it shows a weak correlation with the testosterone levels.
Collapse
Affiliation(s)
- E García-Cruz
- Departamento de Urología, Hospital Plató, Barcelona, España; Departamento of Urología, Hospital Clínic de Barcelona, Barcelona, España.
| | - A Carrión
- Departamento of Urología, Hospital Clínic de Barcelona, Barcelona, España
| | - T Ajami
- Departamento of Urología, Hospital Clínic de Barcelona, Barcelona, España
| | - M Álvarez
- Deparatmento de Urología, Hospital Universitario Infanta Sofía, Madrid, España
| | - M Á Correas
- Departamento de Urología, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - B García
- Unidad de Urología, Hospital Universitario 12 de Octubre, Madrid, España
| | - J V García
- Departamento de Urología, Hospital Universitario Infanta Elena, Valdemoro, Madrid, España; Departamento de Urología, Hospital Universitario Fundación Jiménez Díaz, Madrid, España
| | - C González
- Departamento de Urología, Hospital Universitario Infanta Elena, Valdemoro, Madrid, España; Departamento de Urología, Hospital Universitario Fundación Jiménez Díaz, Madrid, España
| | - J A Portillo
- Departamento de Urología, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - J Romero-Otero
- Unidad de Urología, Hospital Universitario 12 de Octubre, Madrid, España
| | - C Simón
- Departamento de Urología, Hospital Universitario Infanta Elena, Valdemoro, Madrid, España; Departamento de Urología, Hospital Universitario Fundación Jiménez Díaz, Madrid, España
| | - J Torremadé
- Departamento de Urología, Hospital de Bellvitge, Barcelona, España
| | - F Vigués
- Departamento de Urología, Hospital de Bellvitge, Barcelona, España
| | - A Alcaraz
- Departamento of Urología, Hospital Clínic de Barcelona, Barcelona, España
| |
Collapse
|
6
|
Mateu L, García-Cruz E, Asiaín I, Castañeda R, Carrión A, Huguet J, Ribal M, Alcaraz A. A higher Charlson comorbidity index is related to more aggressive characteristics in de novo vesical tumours. Actas Urol Esp 2016; 40:23-8. [PMID: 26231864 DOI: 10.1016/j.acuro.2015.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Revised: 06/17/2015] [Accepted: 06/18/2015] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To analyze the relationship between the age--adjusted Charlson Comorbidity Index (aCCI) and pathological outcomes of transurethral resection of de novo bladder tumours (BT). MATERIAL AND METHODS Data from 208 patients who underwent a transurethral resection (TUR) of a de novo BT between 2007 and 2008 were collected. We recorded the following variables: age, sex, tobacco consumption, comorbidities assessed according to the ICCa (score and mortality rate), disease stage, tumour grade and risk of recurrence and progression. The relationship between the preoperative variables and the final pathological characteristics was analyzed. The multivariate study was conducted with the significant variables (P<.05) from the univariate analysis. RESULTS The mean age of the patients was 69.5 ± 12 years, and 77% were men. The mean ICCa was 6.4 ± 2.5. The final pathology results showed a Tx, T0, Ta, T1 and T ≥ 2 in 5.3, 6.7, 31.7, 26.9, and 28.8% of the cases, respectively. 33.3% of the tumours were low-grade and 66.7% were high-grade. 14.3% of the tumours were associated with carcinoma in situ. Among those non musculo-invasive bladder tumour (non-MIBT), 34.7% had a low risk of recurrence and progression, 18.1% had an intermediate risk and 47.2% had a high risk. The patients with a ICCa ≥ 5 had an increased number of MIBT (RR: 2.29; 1.1-4.8; P=.032), high-grade tumours (RR: 3.1; CI: 1.6-6; P=.001) and tumours with a high risk of recurrence and progression (RR: 2.9; CI: 1.4-5.9; P<.001). CONCLUSION The ICCa is related to the pathological characteristics of de novo BT. Patients with greater comorbidity can present more aggressive tumours. The ICCa could therefore be useful in clinical practice for identifying patients with worse prognosis.
Collapse
|