scholarly journals Charlson Comorbidity Index Is Predictive of Postoperative Clinical Outcome After Single Level Posterior Lumbar Interbody Fusion Surgery: a Single-center Study

2021 ◽  
Author(s):  
Kensuke Shinohara ◽  
Ryo Ugawa ◽  
Shinya Arataki ◽  
Shinnosuke Nakahara ◽  
Kazuhiro Takeuchi
Keyword(s):  
Postoperative Complications ◽  
Clinical Outcome ◽  
Direct Cost ◽  
Charlson Comorbidity Index ◽  
Japanese Orthopaedic Association ◽  
Negative Relationship ◽  
Improvement Rate ◽  
Single Level ◽  
Comorbidity Index ◽  
Group 2

Abstract Background. In several previous studies Charlson comorbidity Index (CCI) score was associated with postoperative complications, mortality and re-admission. There are few reports about the influence of CCI score on postoperative clinical outcome. The purpose of this study was to investigate the influence of comorbidities as calculated with CCI on postoperative clinical outcomes after PLIF.Methods. 366 patients who underwent an elective primary single level PLIF were included. Postoperative clinical outcome was evaluated with the Japanese Orthopaedic Association lumbar score (JOA score). The correlation coefficient between the CCI score and postoperative improvement in JOA score was investigated. Patients were divided into three groups according to their CCI score (0, 1 and 2+). JOA improvement rate, length of stay (LOS) and direct cost were compared between each group. Postoperative complications were also investigated.Results. There was a weak negative relationship between CCI score and JOA improvement rate (r = -0.20). LOS and direct cost had almost no correlation with CCI score. The JOA improvement rate of Group 0 and Group 1 was significantly higher than Group 2+. LOS and direct cost were also significantly different etween Group 0 and Group 2+. There were 14 postoperative complications. Adverse postoperative complications were equivalently distributed in each group, and not associated with the number of comorbidities.Conclusions. A higher CCI score leads to a poor postoperative outcome. The recovery rate of patients with two or more comorbidities was significantly higher than in patients without comorbidities. However, the CCI score did not influence LOS and increased direct costs. The surgeon must take into consideration the patient’s comorbidities when planning a surgical intervention in order to achieve a good clinical outcome.

scholarly journals Charlson comorbidity index is predictive of postoperative clinical outcome after single-level posterior lumbar interbody fusion surgery

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Kensuke Shinonara ◽  
Ryo Ugawa ◽  
Shinya Arataki ◽  
Shinnosuke Nakahara ◽  
Kazuhiro Takeuchi
Keyword(s):  
Postoperative Complications ◽  
Clinical Outcome ◽  
Direct Cost ◽  
Charlson Comorbidity Index ◽  
Japanese Orthopaedic Association ◽  
Negative Relationship ◽  
Improvement Rate ◽  
Single Level ◽  
Comorbidity Index ◽  
Group 2

Abstract Background In several previous studies, Charlson comorbidity index (CCI) score was associated with postoperative complications, mortality, and re-admission. There are few reports about the influence of CCI score on postoperative clinical outcome. The purpose of this study was to investigate the influence of comorbidities as calculated with CCI on postoperative clinical outcomes after PLIF. Methods Three hundred sixty-six patients who underwent an elective primary single-level PLIF were included. Postoperative clinical outcome was evaluated with the Japanese Orthopaedic Association lumbar score (JOA score). The correlation coefficient between the CCI score and postoperative improvement in JOA score was investigated. Patients were divided into three groups according to their CCI score (0, 1, and 2+). JOA improvement rate, length of stay (LOS), and direct cost were compared between each group. Postoperative complications were also investigated. Results There was a weak negative relationship between CCI score and JOA improvement rate (r = − 0.20). LOS and direct cost had almost no correlation with CCI score. The JOA improvement rate of group 0 and group 1 was significantly higher than group 2+. LOS and direct cost were also significantly different between group 0 and group 2+. There were 14 postoperative complications. Adverse postoperative complications were equivalently distributed in each group, and not associated with the number of comorbidities. Conclusions A higher CCI score leads to a poor postoperative outcome. The recovery rate of patients with two or more comorbidities was significantly higher than in patients without comorbidities. However, the CCI score did not influence LOS and increased direct costs. The surgeon must take into consideration the patient’s comorbidities when planning a surgical intervention in order to achieve a good clinical outcome.

scholarly journals Prognostic Risk Factors for Complications Associated with Below the Knee Amputations

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0037
Author(s):  
Jason Ni ◽  
Eric Lukosius ◽  
Kaitlin Saloky ◽  
Kempland Walley ◽  
Leanne Ludwick ◽  
...  
Keyword(s):  
Risk Factors ◽  
Postoperative Complications ◽  
Charlson Comorbidity Index ◽  
High Rate ◽  
Tourniquet Time ◽  
Ambulatory Status ◽  
Asa Classification ◽  
Below The Knee ◽  
Comorbidity Index ◽  
Prognostic Risk Factors

Category: Other Introduction/Purpose: Below the knee amputation (BKA) is an effective surgical procedure for individuals with severe injury or infection to their lower extremities. However, patients who receive these procedures are subject to significant morbidity and a high rate of postoperative complications due to the presence of multiple concomitant comorbidities. Despite the wide practice of this intervention, prognostic risk factors aiding in predicting surgical outcomes in these patients are poorly understood. The purpose of this study is to evaluate risk factors that may contribute to the outcomes of BKA procedures. Methods: The clinical and radiographic outcomes for 89 patients ages 19-90 who underwent BKA were retrospectively evaluated from 2012-2017. Postoperative complications of mortality, infection, and reoperation were evaluated with patient and surgical variables. Patient variables included: age, ambulatory status, obesity, diabetes, HbA1C2 levels, neuropathy, smoking, Charlson Comorbidity Index (CCI), and American Society of Anesthesiologists (ASA) classification. Surgical variables evaluated included: presence of pre-op infection, pre-op ambulatory status, tourniquet time, tourniquet pressure, and usage of prophylactic antibiotics. Results: Of the patients evaluated there was an overall complication rate of 49% (44/89) and a mortality rate of 19% (17/89). Patients with diabetes (p=.035), a greater score on the Charlson Comorbidity Index (p=.001), and an ASA classification =3 (p=.005) were associated with a greater risk of mortality. Operative values (i.e. tourniquet time, tourniquet pressure etc.) did not affect patient mortality rates in a significant way, but there was a higher incidence of complications (i.e. mortality, post-op infections, and reoperations) with patients with pre-operative infections. Conclusion: Diabetes, a higher CCI score and a greater ASA value were found to be significant predictors of patient mortality after BKA (p<0.05). Future perioperative optimization in these patients identified as high risk may improve patient outcomes in the future.

scholarly journals Complications in the 90-day postoperative period following kidney transplant and the relationship of the Charlson Comorbidity Index

2017 ◽  
Vol 11 (12) ◽  
pp. 388-93 ◽  
Author(s):  
Max A. Levine ◽  
Trevor Schuler ◽  
Sita Gourishankar
Keyword(s):  
Logistic Regression ◽  
Postoperative Complications ◽  
Renal Transplant ◽  
Postoperative Period ◽  
Charlson Comorbidity Index ◽  
Significant Risk ◽  
Patient Counselling ◽  
Increased Risk ◽  
Comorbidity Index ◽  
Relationship Of

Introduction: Renal transplant experiences widespread success, but little is published regarding the postoperative complications. The Charlson Comorbidity Index (CCI) is a system of mortality risk assessment. Our purpose is to assess the 90-day postoperative complications after renal transplantation. The secondary objective is to clarify whether CCI predicts complications. We hypothesized increased CCI corresponds to worse complication on the Clavien scale.Methods: This is a retrospective analysis of renal recipients at our institution (2011‒2013) who were ≥18 years old and received complete follow up. CCI, age, gender, body mass index (BMI), and graft type were extracted from the electronic medical records. Complications were scored using the Clavien scale. Descriptive statistics and logistic regression were used to analyze 198 patients.Results: The mean age was 53 (standard deviation [SD] 14), mean BMI 27.4 (SD 14), median CCI 1. Grade 2 or higher (significant) complications occurred in 60% of patients and Grade 3b or higher (severe) in 15% of patients in the 90-day postoperative period. Sixty-eight different complications were identified, the most common being blood transfusion (19%). Logistic regression suggests a predictive value of CCI (odds ratio [OR] 1.70; 95% confidence interval [CI] 1.3‒2.3) for severe complications, with diabetes mellitus and peripheral vascular disease conferring increased risk. Conclusions: Renal transplant carries significant risk. This data can be used to improve patient counselling on the likely postoperative course. Study limitations include the retrospective design, predisposing to potential bias in data capture.

scholarly journals Cervical Single-Level Pincer Stenosis Causing Myelopathy: A Technical Note and Medium-term Results of a One-Session Microsurgical 360-Degree Treatment

2021 ◽  
Author(s):  
Luca Papavero ◽  
Markus Pietrek ◽  
Carlos Joan Marques ◽  
Gregor Schmeiser
Keyword(s):  
Plate Fixation ◽  
Japanese Orthopaedic Association ◽  
Technical Note ◽  
X Rays ◽  
Medium Term ◽  
Improvement Rate ◽  
Single Level ◽  
Postoperative Mri ◽  
The Mean ◽  
Degenerative Cervical Myelopathy

Abstract Background and Study Aims Single-level circumferential or pincer stenosis (PS) affects few patients with degenerative cervical myelopathy (DCM). The surgical technique and medium-term results of a one-session microsurgical 360-degree (m360°) procedure are presented. Patients Between 2013 and 2018, the data of 23 patients were prospectively collected out of 371 patients with DCM. The m360° procedure comprised a microsurgical anterior cervical decompression and fusion (ACDF), with additional plate fixation, followed by flipping the patient and performing a microsurgical posterior bilateral decompression via a unilateral approach in crossover technique. Results The mean age of the patients was 72 years (range: 50–84); 17 patients were males. The mean follow-up time was 12 months (range: 6–31). The patients filled in the patient-derived modified Japanese Orthopaedic Association (P-mJOA) questionnaire on average 53 months after surgery. One patient received a two-level ACDF. Lesions were mostly (92%) located at the C3/C4 (8/24), C4/C5 (7/24), and C5/C6 (7/24) levels. Functional X-rays showed segmental instability in 10 of 23 patients (44%). All preoperative T2-weighted magnetic resonance imaging (MRI) showed an intramedullary hyperintensity. The median preoperative mJOA score was 13 (range 3), and it improved to 16 (range 3) postoperatively. The mean improvement rate in the mJOA score was 73%. When available, postoperative MRI confirmed good circumferential decompression with persistent intramedullary hyperintensity. There were two complications: a long-lasting radicular paresthesia at C6 and a transient C5 palsy. No revision surgery was required. Conclusion The one-session m360° procedure was found to be a safe surgical procedure for the treatment of PS, and the medium-term clinical outcome was satisfactory.

COMPARATIVE ANALYSIS OF THE STRUCTURE OF SOMATIC PATHOLOGY IN PATIENTS WITH MYOMA AND UTERINE CANCER

2020 ◽  
Vol 21 (4) ◽  
pp. 11-15
Author(s):  
E. A. Mateykovich ◽  
◽  
E. А. Soldatova ◽  
V. P. Belov ◽  
Z. F. Khamitova ◽  
...  
Keyword(s):  
Comparative Analysis ◽  
Arterial Hypertension ◽  
Charlson Comorbidity Index ◽  
Uterine Myoma ◽  
Diagnostic Methods ◽  
Hepatobiliary System ◽  
Comorbidity Index ◽  
Group 3 ◽  
Group 2 ◽  
Uterine Body

Objective: to conduct a comparative analysis of the structure of somatic pathology in patients with myoma and cancer of the uterine body. Materials and methods: 522 women were examined, including 40 gynecologically healthy (group 1), 314 patients suffering from uterine myoma (group 2), 168 patients with malignant neoplasms of the uterine body (group 3). All patients, in addition to General clinical, histological and instrumental diagnostic methods, were calculated the Charlson comorbidity index, which determines the presence of concomitant diseases and the prognosis of mortality. Results. A comprehensive assessment of concomitant pathology in patients with group 3 showed that the leading positions among all patients in frequency are occupied by arterial hypertension - 72%, coronary heart disease - 28,6%, obesity - 27,9%, endocrinopathy - 25,6%, gastropathy - 23,1%, pathology of the hepatobiliary system - 20,8%. When analyzing somatic pathology in patients with uterine myoma, it was found that arterial hypertension is most common - 23,6% (3,5 times less often than in group 3), anemia - 26,8% (3.8 times more often than in group 3), endocrinopathy - 10,8% (2,4 times less often than in group 3), gastrotopathy - 15% (0,8 times less often than in group 3), pathology of the hepatobiliary system - 15,2% (0,7 times less than with group 3). At the same time, comorbidity has its own characteristics depending on the main pathology and the age of the patients. Thus, the total number of extragenital pathology in women with group 3 was 73% compared to 27,4% in patients with uterine myoma. The Charlson comorbidity index for group 3 was 1,78 overall, and 0,35 for group 2, which is 5 times lower. Conclusion. The range of somatic conditions in patients with benign and malignant uterine tumors is very wide. The age Association is obvious. The leading positions in the two compared groups are occupied by cardiovascular diseases. The total number of extragenital pathology in women with group 3 is 2,7 times higher, and the comorbidity index is 5 times higher, compared to those in patients with uterine myoma.

Postoperative complications and 90-day mortality in radical cystectomy in high-risk patients: A monocentric retrospective observational study

2018 ◽  
Vol 85 (3) ◽  
pp. 111-117 ◽  
Author(s):  
Carlo Pavone ◽  
Luigi Candela ◽  
Dario Fontana ◽  
Alchiede Simonato
Keyword(s):  
High Risk ◽  
Postoperative Complications ◽  
Observational Study ◽  
Radical Cystectomy ◽  
Charlson Comorbidity Index ◽  
Odds Ratio ◽  
Retrospective Observational Study ◽  
High Risk Patients ◽  
Risk Patients ◽  
Comorbidity Index

Aim: Assessing the incidence of immediate postoperative complications and 90-day mortality in high-risk patients who have undergone radical cystectomy; evaluating the correlation between preoperative conditions and surgery outcomes. Materials and methods: This is a monocentric retrospective observational study in which data of 65 patients have been analyzed. High-risk criteria: (a) Age ≥75 years, (b) obesity, (c) age-adjusted Charlson Comorbidity Index ≥8, (d) anemic status, and (e) pT ≥3. More than 50% of patients had two or more “high-risk” indicators. Postoperative complications were assessed through Clavien–Dindo classification. Results: Average age of patients was 70.4 years, average age-adjusted Charlson Comorbidity Index was 5.8, and average body mass index was 27.5. In 28% of patients, no complications arose, while in 46% grades I–II complications according to Clavien–Dindo occurred, in 23% grades III–IV complications occurred, and in 3% of the patients, death arose in the immediate postoperative period (grade V). Overall, 90-day mortality rate after surgery was 12.3%. The age ≥75 years and an age-adjusted Charlson Comorbidity Index score ≥8 have shown to be risk factors for the onset of severe complications (odds ratio = 3.54, p = 0.028 and odds ratio = 4.7, p = 0.026), while preoperative anemic status was a risk factor for complications in general (odds ratio = 4.1, p = 0.015). No analyzed parameter was a predictor of 90-day mortality ( p > 0.05). Conclusion: Immediate postoperative complications and 90-day mortality in radical cystectomy in high-risk patients remain significant, but still in line with the data in the literature on comparable populations. Some of the preoperative parameters were able to predict the outcomes of the intervention with regard to the onset of complications but not to the 90-day mortality.

The impact of polypharmacy and comorbidities on surgical morbidity and mortality in patients with gynecological malignancies: Results of a prospective study in 237 patients.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e18255-e18255
Author(s):  
Guelhan Inci ◽  
Hannah Woopen ◽  
Rolf Richter ◽  
Radoslav Chekerov ◽  
Mustafa Zelal Muallem ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Charlson Comorbidity Index ◽  
Clinical Characteristics ◽  
Gynecologic Cancer ◽  
Cancer Surgery ◽  
Morbidity And Mortality ◽  
Duration Of Surgery ◽  
Comorbidity Index ◽  
The Impact ◽  
Preoperative Albumin

e18255 Background: Physicians need to risk-stratify their patients preoperatively to adjust the radicality and the indication of surgery. So far, there are only retrospective and limiting data available. Aim of this study is to evaluate the predictive clinical characteristics such as polypharmacy and Charlson-Comorbidity Index (CCI) for postoperative complications in patients undergoing gynecologic cancer surgery. Methods: This is a prospective cohort study of patients undergoing gynecologic cancer surgery at a tertiary care academic center from October 2015 through January 2017. Surgical complications were graded using validated Clavien-Dindo criteria. Using logistic regression, we identified demographic and predictive clinical characteristics for postoperative complications. Results: Out of the 237 enrolled patients 41(17.3%) experienced a grade≥3b complication. Within 30 days of surgery, 9 (3.8%) patients has died. Charlson Comorbidity index (CCI)> 2(p<0.015, OR 2.33, 95% CI 1.18-4.61), polypharmacy (p<0.001, OR 3.40, 95% CI 1.63-7.10), ASA (p<0.0001, OR 2.98, 95% CI 1.65-5.38), BMI>25kg/m2 (p<0.001, OR 4.25, 95% CI 1.86-9.69), preoperative albumin<3.5 g/dl (p<0.009, OR 3.22, 95% CI 1.33-7.79) and potassium < 3.6 mmol/L (p=0.007, OR 5.11, 95% CI 1.55-16.81) were predictive for complications grade≥3b. A multivariable model included duration of surgery (p=0.012, OR 1.26, 95% CI 1.05-1.52), ASA (p=0.01, OR 2.60, 95% CI 1.20-5.60), preoperative albumin<3.5 g/dl (p=0.028, OR 3.37, 95% CI 1.14-10.00), BMI >25kg/m2 (p=0.009, OR 3.81, 95% CI 1.40-10.35) and potassium < 3.6 mmol/L (p=0.02, OR 3.69, 95% CI 1.20-11.38) was predictive of 30-day Morbidity and Mortality. Age (p=0.49, OR 0.89, 95% CI 0.95-1.02), CCI > 2(p=0.88, OR 1.06, 95% CI 0.42-2.69) and polypharmacy (p=0.65, OR 1.26, 95% CI 0.41-3.98) showed no association for postoperative complications. Conclusions: Only ASA, BMI, preoperative albumin and potassium are associated with severe postoperative complications in patients undergoing gynecologic cancer surgery. Subsequent studies should confirm this result to identify better frail cancer patients.

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