Robert G Whitmore1, James H Stephen1, Coleen Vernick2, Peter G Campbell3, Sanjay Yadla3, George M Ghobrial3, Mitchell G Maltenfort3, John K Ratliff4. 1. Department of Neurosurgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA. 2. Department of Anesthesiology, Thomas Jefferson University, 3400 Spruce Street, Philadelphia, PA 19107, USA. 3. Department of Neurosurgery, Thomas Jefferson University, 111 S 11th Street, Philadelphia, PA 19107, USA. 4. Department of Neurosurgery, Thomas Jefferson University, 111 S 11th Street, Philadelphia, PA 19107, USA. Electronic address: john.ratliff@jefferson.edu.
Abstract
BACKGROUND CONTEXT: The Charlson Comorbidity Index (CCI) and the American Society of Anesthesiologists (ASA) Physical Status Classification System (ASA grade) are useful for predicting morbidity and mortality for a variety of disease processes. PURPOSE: To evaluate CCI and ASA grade as predictors of complications after spinal surgery and examine the correlation between these comorbidity indices and the cost of care. STUDY DESIGN/ SETTING: Prospective observational study. PATIENT SAMPLE: All patients undergoing any spine surgery at a single academic tertiary center over a 6-month period. OUTCOME MEASURES: Direct health-care costs estimated from diagnosis related group and Current Procedural Terminology (CPT) codes. METHODS: Demographic data, including all patient comorbidities, procedural data, and all complications, occurring within 30 days of the index procedure were prospectively recorded. Charlson Comorbidity Index was calculated from International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes and ASA grades determined from the operative record. Diagnosis related group and CPT codes were captured for each patient. Direct costs were estimated from a societal perspective using Medicare rates of reimbursement. A multivariable analysis was performed to assess the association of the CCI and ASA grade to the rate of complication and direct health-care costs. RESULTS: Two hundred twenty-six cases were analyzed. The average CCI score for the patient cohort was 0.92, and the average ASA grade was 2.65. The CCI and ASA grade were significantly correlated, with Spearman ρ of 0.458 (p<.001). Both CCI and ASA grade were associated with increasing body mass index (p<.01) and increasing patient age (p<.0001). Increasing CCI was associated with an increasing likelihood of occurrence of any complication (p=.0093) and of minor complications (p=.0032). Increasing ASA grade was significantly associated with an increasing likelihood of occurrence of a major complication (p=.0035). Increasing ASA grade showed a significant association with increasing direct costs (p=.0062). CONCLUSIONS: American Society of Anesthesiologists and CCI scores are useful comorbidity indices for the spine patient population, although neither was completely predictive of complication occurrence. A spine-specific comorbidity index, based on ICD-9-CM coding that could be easily captured from patient records, and which is predictive of patient likelihood of complications and mortality, would be beneficial in patient counseling and choice of operative intervention.
BACKGROUND CONTEXT: The Charlson Comorbidity Index (CCI) and the American Society of Anesthesiologists (ASA) Physical Status Classification System (ASA grade) are useful for predicting morbidity and mortality for a variety of disease processes. PURPOSE: To evaluate CCI and ASA grade as predictors of complications after spinal surgery and examine the correlation between these comorbidity indices and the cost of care. STUDY DESIGN/ SETTING: Prospective observational study. PATIENT SAMPLE: All patients undergoing any spine surgery at a single academic tertiary center over a 6-month period. OUTCOME MEASURES: Direct health-care costs estimated from diagnosis related group and Current Procedural Terminology (CPT) codes. METHODS: Demographic data, including all patient comorbidities, procedural data, and all complications, occurring within 30 days of the index procedure were prospectively recorded. Charlson Comorbidity Index was calculated from International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes and ASA grades determined from the operative record. Diagnosis related group and CPT codes were captured for each patient. Direct costs were estimated from a societal perspective using Medicare rates of reimbursement. A multivariable analysis was performed to assess the association of the CCI and ASA grade to the rate of complication and direct health-care costs. RESULTS: Two hundred twenty-six cases were analyzed. The average CCI score for the patient cohort was 0.92, and the average ASA grade was 2.65. The CCI and ASA grade were significantly correlated, with Spearman ρ of 0.458 (p<.001). Both CCI and ASA grade were associated with increasing body mass index (p<.01) and increasing patient age (p<.0001). Increasing CCI was associated with an increasing likelihood of occurrence of any complication (p=.0093) and of minor complications (p=.0032). Increasing ASA grade was significantly associated with an increasing likelihood of occurrence of a major complication (p=.0035). Increasing ASA grade showed a significant association with increasing direct costs (p=.0062). CONCLUSIONS: American Society of Anesthesiologists and CCI scores are useful comorbidity indices for the spine patient population, although neither was completely predictive of complication occurrence. A spine-specific comorbidity index, based on ICD-9-CM coding that could be easily captured from patient records, and which is predictive of patient likelihood of complications and mortality, would be beneficial in patient counseling and choice of operative intervention.
Authors: Pascal Zehnder; Ulrike Held; Tim Pigott; Andrea Luca; Markus Loibl; Raluca Reitmeir; Tamás Fekete; Daniel Haschtmann; Anne F Mannion Journal: Eur Spine J Date: 2021-03-09 Impact factor: 3.134
Authors: Maximilian F Kasparek; Friedrich Boettner; Anna Rienmueller; Michael Weber; Philipp T Funovics; Petra Krepler; Reinhard Windhager; Josef Grohs Journal: Eur Spine J Date: 2018-07-28 Impact factor: 3.134
Authors: Remi M Ajiboye; Mark A Eckardt; Jason T Hamamoto; Benjamin Plotkin; Michael D Daubs; Jeffrey C Wang Journal: Int J Spine Surg Date: 2016-10-17
Authors: William K Oelsner; Stephen M Engstrom; Michael A Benvenuti; Thomas J An; Richard A Jacobson; Gregory G Polkowski; Jonathan G Schoenecker Journal: J Arthroplasty Date: 2016-07-15 Impact factor: 4.757
Authors: Ankur S Narain; Fady Y Hijji; Brittany E Haws; Benjamin Khechen; Krishna T Kudaravalli; Kelly H Yom; Kern Singh Journal: Int J Spine Surg Date: 2020-06-30
Authors: Ferran Pellisé; Alba Vila-Casademunt; Montse Ferrer; Montse Domingo-Sàbat; Juan Bagó; Francisco J S Pérez-Grueso; Ahmet Alanay; A F Mannion; Emre Acaroglu Journal: Eur Spine J Date: 2014-09-14 Impact factor: 3.134
Authors: Ankur S Narain; Fady Y Hijji; Brittany E Haws; Benjamin Khechen; Krishna T Kudaravalli; Kelly H Yom; Kern Singh Journal: Int J Spine Surg Date: 2020-02-29