Elixhauser Comorbidity Measure is Superior to Charlson Comorbidity Index In-Predicting Hospital Complications Following Elective Posterior Cervical Decompression and Fusion

Abstract

The predictive ability of Elixhauser Comorbidity Index (ECI) and Charlson Comorbidity Index (CCI) have been compared in orthopedic and gastrointestinal surgery; however, their predictive ability for complications secondary to spine surgery and posterior cervical decompression and fusion (PCDF) specifically is understudied. This study examines the predictive ability of the ECI and CCI for complications and morbidity following PCDF. ECI and CCI were retrospectively computed for all PCDF cases in the National Inpatient Sample database from 2013 to 2014 and complications or morbidity were identified. C-statistics were used to analyze ECI and CCI predictive ability in a range of complications and compared with a base comorbidity model that included age, sex, race, and primary payer. PCDF was performed in 46,700 hospitalizations between 2013 and 2014. The complications for which ECI was found to be a significantly better predictor included airway complications (69.16% superior to CCI), hemorrhagic anemia (79.04% superior), cardiac arrest (72.39% superior), pulmonary embolism (83.01% superior), sepsis (62.44% superior), septic shock (78.90% superior), urinary tract infection (63.53% superior), death (74.28% superior), any minor complication (75% superior), any major complication (133% superior), and any complication at all (63.72% superior). The complications for which neither the ECI Index nor the CCI proved superior were acute kidney injury, myocardial infarction, cerebrovascular accident, deep vein thrombosis, pneumonia, wound dehiscence, and superficial surgical-site infection following PCDF. ECI showed superior predictive ability to the CCI in predicting 8 of the 18 complications that were analyzed and inferior in none.