Comorbidity Measures Research Articles

Differences in Patient-Reported Outcomes Between Anterior and Posterior Approaches for Treatment of Cervical Spondylotic Myelopathy: A Quality Outcomes Database Analysis

Surgery for cervical spondylotic myelopathy (CSM) may use anterior or posterior approaches. Our objective was to compare baseline differences and validated postoperative patient-reported outcome measures between anterior and posterior approaches. The NeuroPoint Quality Outcomes Database was queried retrospectively to identify patients with symptomatic CSM treated at 14 high-volume sites. Demographic, comorbidity, socioeconomic, and outcome measures were compared between treatment groups at baseline and 3 and 12 months postoperatively. Of the 1151 patients with CSM in the cervical registry, 791 (68.7%) underwent anterior surgery and 360 (31.3%) underwent posterior surgery. Significant baseline differences were observed in age, comorbidities, myelopathy severity, unemployment, and length of hospital stay. After adjusting for these differences, anterior surgery patients had significantly lower Neck Disability Index score (NDI) and a higher proportion reaching a minimal clinically important difference (MCID) in NDI (P= 0.005 at 3 months; P= 0.003 at 12 months). Although modified Japanese Orthopaedic Association scores were lower in anterior surgery patients at 3 and 12 months (P < 0.001 and P= 0.022, respectively), no differences were seen in MCID or change from baseline. Greater EuroQol-5D improvement at 3 months after anterior versus posterior surgery (P= 0.024) was not sustained at 12 months and was insignificant on multivariate analysis. In the largest analysis to date of CSM surgery data, significant baseline differences existed for patients undergoing anterior versus posterior surgery for CSM. After adjusting for these differences, patients undergoing anterior surgery were more likely to achieve clinically significant improvement in NDI at short- and long-term follow-up.

Spatial Distribution of COVID-19 and Comorbidities in New England

The COVID-19 pandemic created new barriers and challenges to accessing primary care services, particularly among older adults who already faced barriers related to access to care, including transportation, health literacy, and self-management support. Nova Southeastern University South Florida Geriatric Workforce Enhancement Program (NSU SFGWEP) partnered with primary care clinics to conduct wellness calls to older adult patients identified through clinic EHR. The wellness calls’ objectives were to 1) discuss COVID-19 protective measures; 2) assess wellness needs and access to care barriers; and 3) screen for telehealth support. From September 2020 to February 2021, the team (including medical students, public health students, and SFGWEP staff) contacted 200 patients via telephone and conducted a comprehensive wellness survey developed by the study team, informed by validated surveys. Among the 200 patients called, 60% (n=34) were very concerned about the Covid-19 pandemic, 33% (n=34) reported often feeling isolated from others, and 20% (n=34) expressed difficulty getting medical care. A smaller subset of patients reported concern about limited COVID-19 testing (n=1), lack of knowledge about seeing their provider via telehealth (n=7), lack of face masks (n=1), and challenges with obtaining medication refills (n=1). Following wellness calls, the NSU SFGWEP team provided education, referred to clinical resources, and, for low-income patients with access to care challenges, provided Samsung Tablets (n=50) with peer training to enable telehealth.

22. An Innovative Approach to Examining the Waning of Vaccine Effectiveness Using Automated Healthcare Data

BackgroundWe conducted a large real-world study of the long-term vaccine effectiveness (VE) of the live attenuated zoster vaccine (Zostavax; ZVL). Using an innovative approach with automated observational data we measured VE for incident herpes zoster (HZ) and severe HZ outcomes including post-herpetic neuralgia (PHN), herpes zoster ophthalmicus (HZO), and hospitalized HZ. This approach could be useful in long-term effectiveness studies of other vaccines.MethodsWe assessed VE against HZ, PHN, HZO and hospitalized HZ for up to 10+ years after vaccination at Kaiser Permanente Northern California. We identified incident cases using diagnoses, laboratory tests and prescriptions, and validated a sample by chart review. For each outcome, we used a Cox regression model with a calendar timeline to estimate VE in relation to year since vaccination. The model for HZ included 11 time-varying vaccination status indicators to denote -- at each timepoint during follow-up -- either the number of years since ZVL vaccination (30 days to < 1 year, 1 to < 2 years, . . ., and 10+ years) or that the individual is unvaccinated (reference group). Analyses were adjusted for demographics and time-varying measures of immune compromise status, healthcare use and comorbidities. ResultsFrom 2007-2018, 1.5 million people contributed to analyses; 507,000 (34%) were vaccinated. During 9 million person-years of follow-up, we observed 75,135 HZ cases, including 4,982 (7%) with PHN, 4,418 (6%) with HZO, and 555 (< 1%) who were hospitalized. VE for HZ was 67% (95% Confidence Interval [CI]: 65-69%) in the first year after vaccination, waned to 50% (CI: 47-52%) in the second year after vaccination, and then waned more gradually to 15% (CI: 5-24%) by 10+ years after vaccination. Initial VE was higher against PHN (83%; CI: 78-87%) and hospitalized HZ (89%; CI: 67-97%) with less waning observed over time (42% by Year 8 for PHN and 53% in Years 5 to < 8 for hospitalized HZ). VE against HZO was 71% in Year 1 and waned to 29% in Years 5 to < 8. ConclusionOur large population, long follow-up and innovative methods let us estimate VE against HZ, PHN, HZO and hospitalized HZ for 10+ years after vaccination. Our approach could help assess waning and need for boosters for vaccines against other agents including COVID-19.Disclosures Morgan Marks, PhD, ScM, Merck & Co Inc. (Employee) Patricia Saddier, MD, PhD, Merck & Co Inc (Employee) Nicola P. Klein, MD, PhD, GlaxoSmithKline (Grant/Research Support)MedImmune (Grant/Research Support)Merck & Co Inc (Grant/Research Support)Pfizer (Grant/Research Support)Protein Sciences (now Sanofi Pasteur) (Grant/Research Support)Sanofi Pasteur (Grant/Research Support)

Can extant comorbidity indices identify patients who experience poor outcomes following total joint arthroplasty?

It is uncertain if generic comorbidity indices commonly used in orthopedics accurately predict outcomes after total hip (THA) or knee arthroplasty (TKA). The purpose of this study was to determine the predictive ability of such comorbidity indices for: (1) 30-day mortality; (2) 30-day rate of major and minor complications; (3) discharge disposition; and (4) extended length of stay (LOS). The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was retrospectively reviewed for all patients who underwent elective THA (n = 202,488) or TKA (n = 230,823) from 2011 to 2019. The American Society of Anesthesiologists (ASA) physical status classification system score, modified Charlson Comorbidity Index (mCCI), Elixhauser Comorbidity Measure (ECM), and 5-Factor Modified Frailty Index (mFI-5) were calculated for each patient. Logistic regression models predicting 30-day mortality, discharge disposition, LOS greater than 1 day, and 30-day major and minor complications were fit for each index. The ASA classification (C-statistic = 0.773 for THA and TKA) and mCCI (THA: c-statistic = 0.781; TKA: C-statistic = 0.771) were good models for predicting 30-day mortality. However, ASA and mCCI were not predictive of major and minor complications, discharge disposition, or LOS. The ECM and mFI-5 did not reliably predict any outcomes of interest. ASA and mCCI are good models for predicting 30-day mortality after THA and TKA. However, similar to ECM and mFI-5, these generic comorbidity risk-assessment tools do not adequately predict 30-day postoperative outcomes or in-hospital metrics. This highlights the need for an updated, data-driven approach for standardized comorbidity reporting and risk assessment in arthroplasty.

Chronic Lymphocytic Leukemia Comorbidity Index (CLL-CI), a Novel Comorbidity Measure, Predicts Outcomes in the Context of Targeted Agents and in a Large National Registry

Chronic Lymphocytic Leukemia Comorbidity Index (CLL-CI), a Novel Comorbidity Measure, Predicts Outcomes in the Context of Targeted Agents and in a Large National Registry

Performance of Three Measures of Comorbidity in Predicting Critical COVID-19: A Retrospective Analysis of 4607 Hospitalized Patients.

BackgroundComorbidity burden has been identified as a relevant predictor of critical illness in patients hospitalized with coronavirus disease 2019 (COVID-19). However, comorbidity burden is often represented by a simple count of few conditions that may not fully capture patients’ complexity.PurposeTo evaluate the performance of a comprehensive index of the comorbidity burden (Queralt DxS), which includes all chronic conditions present on admission, as an adjustment variable in models for predicting critical illness in hospitalized COVID-19 patients and compare it with two broadly used measures of comorbidity.Materials and MethodsWe analyzed data from all COVID-19 hospitalizations reported in eight public hospitals in Catalonia (North-East Spain) between June 15 and December 8 2020. The primary outcome was a composite of critical illness that included the need for invasive mechanical ventilation, transfer to ICU, or in-hospital death. Predictors including age, sex, and comorbidities present on admission measured using three indices: the Charlson index, the Elixhauser index, and the Queralt DxS index for comorbidities on admission. The performance of different fitted models was compared using various indicators, including the area under the receiver operating characteristics curve (AUROCC).ResultsOur analysis included 4607 hospitalized COVID-19 patients. Of them, 1315 experienced critical illness. Comorbidities significantly contributed to predicting the outcome in all summary indices used. AUC (95% CI) for prediction of critical illness was 0.641 (0.624–0.660) for the Charlson index, 0.665 (0.645–0.681) for the Elixhauser index, and 0.787 (0.773–0.801) for the Queralt DxS index. Other metrics of model performance also showed Queralt DxS being consistently superior to the other indices.ConclusionIn our analysis, the ability of comorbidity indices to predict critical illness in hospitalized COVID-19 patients increased with their exhaustivity. The comprehensive Queralt DxS index may improve the accuracy of predictive models for resource allocation and clinical decision-making in the hospital setting.

Correlation Between Visual Factors During Patient Transfer and Objective Measures of Operative Risk in Preoperative Risk Assessment

<h3>Introduction and Objectives</h3> Frailty, an important consideration for determining a patient's surgical risk, is usually assessed informally based on clinical gestalt—the "eye-ball test." Surgeons are usually skilled at identifying high-risk patients, however, the factors underlying their unstructured assessments are unknown. The objective of our study was to explore the visual factors that may be used in an "eye-ball test" and understand how they compare to objective measures of frailty, multiple comorbidities, and operative risk. <h3>Methods</h3> A convergent mixed methods design was utilized to compare factors present in video recordings of patients transferring from a chair to exam table during vascular clinic visits to objective measures of surgical risk, including grip strength, modified frailty index-5 (mFI-5), and Fried Frailty Score. The videos were qualitatively evaluated by three independent coders. Patient transfer began in seated position in chair, followed by ambulation and transfer to the exam table, and ended in seated position on the exam table (Figure 1). Transfer length of time was measured in seconds based on time stamps. T-tests were used to compare length of transfer and Fisher's exact test was used to examine associations between visual factors and the objective measures of operative risk.Figure 1Components of a patient transfer from chair to exam table in the clinic setting. This segmentation was utilized for analysis of the video-recorded patient transfers.Figure 1 <h3>Results</h3> 30 patients and their video-taped transfers from two centers were analyzed. Mean age of participants was 71.9±9.45 years, 43.3% were female, and 18% identified with non-white race. Approximately half were categorized as frail by mFI-5 score and 50% were weak by grip strength measurement (65% convergence; P=.37). Frail patients had a longer transfer time (mean 11.6 vs 9.9 seconds; P=.19). A median of 45 coded factors based on visually present patient appearance and movement were coded. Patients who were considered frail more often used their arms to push up from sitting position (69.2% vs 25.0%; P=.04), have a medical device visible (e.g., portable oxygen, orthotic shoe, insulin pump) (38.5% vs 0%; P=.04), have a walking assistive device present (e.g., wheelchair, cane) (23.1% vs 0%; P=.22), and displayed postural instability during transfer from chair to exam table (50% vs 8.3%; P=.07). There appeared to be no difference in the presence of no-lace shoes (46.2% vs 41.7%; P=.82). <h3>Conclusions</h3> This pilot study reveals patient appearance and movement correlate with objective measures of operative risk. These visual factors may underlie unstructured frameworks utilized by vascular surgeons during preoperative risk assessment. Future work will build on this work by exploring surgeon's assessment in comparison to the visually coded factors in this study through case simulations.

Deficiency in the Essential Amino Acids l-Isoleucine, l-Leucine and l-Histidine and Clinical Measures as Predictors of Moderate Depression in Elderly Women: A Discriminant Analysis Study.

Increases in depression are common in some elderly women. Elderly women often show moderate depressive symptoms, while others display minimal depressive symptoms. These discrepancies have produced contradictory and inconclusive outcomes, which have not been explained entirely by deficits in neurotransmitter precursors. Deficiency in some amino acids have been implicated in major depression, but its role in non-clinical elderly women is not well known. An analysis of essential amino acids, depression and the use of discriminant analysis can help to clarify the variation in depressive symptoms exhibited by some elderly women. The aim was to investigate the relationship of essential amino acids with affective, cognitive and comorbidity measures in elderly women without major depression nor severe mood disorders or psychosis, specifically thirty-six with moderate depressive symptoms and seventy-one with minimal depressive symptoms. The plasma concentrations of nineteen amino acids, Beck Depression Inventory (BDI) scores, Geriatric Depression Scale (GDS) scores, global cognitive scores and comorbidities were submitted to stepwise discriminant analysis to identify predictor variables. Seven predictors arose as important for belong to the group based on amino acid concentrations, with the moderate depressive symptoms group characterized by higher BDI, GDS and cognitive scores; fewer comorbidities; and lower levels of l-histidine, l-isoleucine and l-leucine. These findings suggest that elderly women classified as having moderate depressive symptoms displayed a deficiency in essential amino acids involved in metabolism, protein synthesis, inflammation and neurotransmission.

Bariatric surgery is associated with lower risk of acute cardiovascular events in patients with obesity and hypertrophic cardiomyopathy

Abstract Background Prior studies have suggested causal relationships between obesity and acute cardiovascular events (e.g., acute coronary syndrome, hypertensive crisis, and heart failure exacerbation). It has been known that the risk of cardiovascular events is reduced by bariatric surgery, the most effective method for substantial and sustained weight loss. However, little is known about whether bariatric surgery lowers the risk of acute cardiovascular events in the hypertrophic cardiomyopathy (HCM) population. Purpose To test the hypothesis that patients with obesity and HCM who underwent bariatric surgery have lower risk of developing acute cardiovascular events than those who did not. Methods In this population-based study of adults with obesity and HCM, the bariatric surgery group consisted of patients who underwent bariatric surgery from January 2004 to December 2014, whereas the control group included those who received non-bariatric elective intra-abdominal surgery during the same period. The outcome was an acute cardiovascular event – defined as emergency department (ED) visit or unplanned hospitalization for cardiovascular disease – during a 1-year post-surgery period. We used the SPARCS database, a population-based ED and inpatient database that captures all the ED visits and hospitalizations in New York State. We constructed logistic regression models with generalized estimating equations to compare the risk of the outcome events during sequential 6-month periods. We conducted multivariable analysis, adjusting for age, sex, number of ED visits and hospitalizations for cardiovascular disease within 2 years before the index surgery, and the Elixhauser comorbidity measures. We also performed additional analyses with propensity score (PS)-matching at 2:1 ratio and inverse probability treatment weighting (IPTW) using these variables. Results The analytic cohort consisted of 207 adults with obesity and HCM, including 147 patients who underwent bariatric surgery and 60 who had non-bariatric elective intra-abdominal surgery. In the 7–12 months post-surgery period, the risk of acute cardiovascular event was significantly lower in the bariatric surgery group (adjusted OR 0.23; 95% CI, 0.068–0.71; P=0.01; Figure) compared to the control group. In the PS-matched cohort (n=82 vs. 47), there were no significant differences in the baseline characteristics (P&amp;gt;0.50 for all comparisons). Similar to the main analysis, the PS-matched analysis demonstrated lower risk of the outcome event in the bariatric surgery group in the 7–12 months post-surgery period (OR 0.26; 95% CI, 0.083–0.73; P=0.01). The IPTW analysis also replicated the findings (OR 0.33; 95% CI, 0.16–0.71; P=0.004 during the 7–12 months post-surgery period). Conclusion In this population-based study of 207 adults with obesity and HCM, bariatric surgery was associated with a lower risk of acute cardiovascular events in the 7–12 months post-surgery period in real-world settings. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Institute of Health (USA) and American Heart Association

A comorbid mental disorder paradox: Using causal diagrams to understand associations between posttraumatic stress disorder and suicide.

Although some studies document that posttraumatic stress disorder (PTSD) increases suicide risk, other studies have produced the paradoxical finding that PTSD decreases suicide risk. We sought to understand methodologic biases that may explain these paradoxical findings through the use of directed acyclic graphs (DAGs). DAGs are causal diagrams that visually encode a researcher's assumptions about data generating mechanisms and assumed causal relations among variables. DAGs can connect theories to data and guide statistical choices made in study design and analysis. In this article, we describe DAGs and explain how they can be used to identify biases that may arise from inappropriate analytic decisions and data limitations. We define a particular form of bias, collider bias, that is a likely explanation for why studies have found a supposedly protective association of PTSD with suicide. This protective association is interpreted by some researchers as evidence that PTSD reduces the risk of suicide. Collider bias may occur through inappropriate adjustment for a psychiatric comorbidity, such as adjustment for variables that are affected by PTSD and share common causes with suicide. We recommend that researchers collect longitudinal measurements of psychiatric comorbidities, which would help establish the temporal ordering of variables and avoid the biases discussed in this article. Furthermore, researchers could use DAGs to explore how results may be impacted by design and analytic decisions prior to execution. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Enhanced sensory conduction in primary fibromyalgia: a case\u2013control pilot study

BackgroundThis study aimed to test the changes in the conduction properties of peripheral nerves in patients with primary fibromyalgia (FM). Thirty patients with FM and sixteen healthy controls participated in this study. Visual analogue scale (VAS) for pain severity, pain duration, Widespread Pain Index (WPI), Symptom Severity (SS) scale, Hamilton depression rating scale, Taylor’s manifest anxiety scale, and Fibromyalgia Impact Questionnaire (FIQR) were used for measurement of psychiatric comorbidities and quality of life for each patient. Routine motor and sensory nerve conduction studies of both median, ulnar, common peroneal, posterior tibial, and sural nerves were measured for all study participants.ResultsWe found statistically significant increase in Sensory Conduction Velocity (SCV), Sensory Nerve Action Potential (SNAP) amplitude, and decrease in Sensory Latency (SL) in patients with FM compared to controls. There were no significant changes in motor nerve conduction between patients and controls. Regression analysis showed a significant relation between WPI and both SCV and SL especially in nerves of upper limbs. However, no significant relation between SCV and SL and other presumed predictors including VAS for pain severity, pain duration, SS scale, FIQR, and psychiatric comorbidities. Patients with FM suffered more depression and anxiety than controls.ConclusionsWe found enhanced conductivity of the sensory rather than the motor nerves in patients with FM. To our knowledge, this is the first study to describe these sensory changes which may add further evidence of peripheral sensitization in patients with FM.

The relationship between 19-year trends in medication use and changes in physical function among women in the mid-life: A Study of Women's Health Across the Nation pharmacoepidemiology study.

Medication side effects are a major concern in aging adults who report using an increasing number of medications. The relationship between accumulating medication use and physical function has not been examined in a longitudinal cohort. We conducted a longitudinal cohort study using prospectively collected data from the Study of Women's Health Across the Nation (SWAN). Community-dwelling women from five US cities were followed for up to 20 years. The exposure of interest was the number of prescription medications. They were examined as a count variable and then for specific categories of medication. The outcome of interest was physical function measured repeatedly using the short form (SF)-36 physical function (PF) scale. Linear mixed models, using repeated measures of sociodemographics and comorbidities were assessed. 1452 participants qualified for the analyses with a median follow-up of 19.2 years. At baseline, the mean age was 46.5 years and 53.5% reported White race. Fully adjusted models demonstrated a reduction in the SF-36 PF of 0.99 for each additional prescription medication used or a 6.14-point reduction for women reporting more than five medications and an 8.92-point reduction among those reporting more than 10 medications. These results were similar across race and ethnicity. Specific medication categories with a significant and largely negative impact (at least a two-point reduction) on physical component score included beta-blockers, analgesics, glucocorticoids, anticonvulsants, anxiolytics, anticoagulants, and anti-depressants. There is a moderate association between increasing medication use and decreasing physical function among women transitioning through the mid-life.

The Relationship Between Frailty, Comorbidity and COVID-19 Mortality in Older COVID-19 Patients: Analysis of an Administrative Dataset Using Machine Learning Techniques

Introduction: Older adults have disproportionally poor outcomes following hospitalisation with COVID-19, but within this group there is substantial variation. Although frailty and comorbidity are key determinants of mortality, it is less clear which specific manifestations of frailty and comorbidity are associated with the poorest outcomes. The aim of this study was to identify the key comorbidities and functional manifestations of frailty that were associated with in-hospital mortality in older patients with COVID-19.Methods: This was a retrospective study that used the Hospital Episode Statistics administrative dataset from 1st March 2020 to 28th February 2021 for hospital patients in England aged 65 years and over. Frailty was assessed using the Dr Foster Global Frailty Scale (GFS) and comorbidity using the Charlson Comorbidity Index (CCI). Exploratory analysis techniques were used to determine mortality according to the demographic, frailty and comorbidity profile of patients. Features were selected, pre-processed and inputted into a random forest classification algorithm to predict in-hospital mortality.Results: In total 215,831 patients were included. The frailty and comorbidity measures significantly improved the model’s ability to predict mortality in patients. The most important frailty items in the GFS were dementia/delirium, falls/fractures and pressure ulcers/weight loss. The most-important comorbidity items in the CCI were diabetes (without complications), pulmonary disease, heart failure and renal failure. The best-performing model had a predictive accuracy of 70% as well as an area under the curve of 0.78.Discussion: Frailty and comorbidity are associated with poorer COVID-19 outcomes in older adults, even after adjusting for chronological age. The physical manifestation of frailty and comorbidity particularly a history of cognitive impairment and falls, may be useful in identification of patients who may need additional support during their hospital stay.Funding: None to declare.Declaration of Interest: None to declare.

An examination of abstinence social support among recovery home residents with psychiatric comorbidity

BackgroundAlthough social support is a resource that helps persons in their recovery from substance use disorders, it is not clear whether specific types buffer the effects of stress and optimize outcomes for those with psychiatric comorbidity. This investigation examined two types of social support in relation to lengths of stay to identify mechanisms related to retention among individuals with psychiatric comorbidity living in community-based settings. MethodsBaseline rates of social support (abstinence specific and general types) and stress were examined in relation to follow-up lengths of stay (at four-months and beyond) among individuals (N = 368) with psychiatric comorbidity (n = 90) and no psychiatric comorbidity (n = 278) living in community-based settings (Oxford Houses) in the U.S. The psychiatric severity index of the Addiction Severity Index was used as a proxy measure of psychiatric comorbidity. Moderated mediation analyses were conducted to test the potential mediating effects of abstinence social support and general social support on the relationship between stress and lengths of stay, and whether these were influenced by psychiatric comorbidity. ResultsA full mediating effect was observed for abstinence social support for residents with psychiatric comorbidity, whereas a partial mediating effect for general social support was observed for all residents. ConclusionsFindings demonstrate qualities of social support have differential effects, substantiating the notion that specific components of social support optimize outcomes for those with psychiatric comorbidity living in recovery homes.

EDITORIAL COMMENT

In this interesting study, an automatically calculated electronic comorbidity measure, the Care Assessment Needs (CAN) score, was studied as predictor of life expectancy in a huge Veterans Health Administration (VHA) patient sample. 1 N. N. et al. Using an automated electronic health record score to estimate life expectancy in men diagnosed with prostate cancer in the Veterans Health Administration. Urology. 2021; ([in press]) Google Scholar The score was originally designed to estimate short-term risks of hospitalization and mortality. The authors demonstrated a strong association of the CAN score with medium-term mortality after prostate cancer diagnosis. 1 N. N. et al. Using an automated electronic health record score to estimate life expectancy in men diagnosed with prostate cancer in the Veterans Health Administration. Urology. 2021; ([in press]) Google Scholar Although this instrument may be automatically available in VHA patients, its high complexity may hinder its routine use in different institutions. Instruments predicting life expectancy to support treatment selection in men with early prostate cancer should not only be accurate but also simple to use. 2 Daskivich TJ Kwan L Dash A et al. Weighted versus unweighted Charlson score to predict long-term other-cause mortality in men with early-stage prostate cancer. Eur Urol. 2014; 66: 1002-1009 Abstract Full Text Full Text PDF PubMed Scopus (20) Google Scholar In contrast to some contrary claims, 3 Walz J Gallina A Perrotte P et al. Clinicians are poor raters of life-expectancy before radical prostatectomy or definitive radiotherapy for localized prostate cancer. BJU Int. 2007; 100: 1254-1258 Crossref PubMed Scopus (113) Google Scholar at least in candidates for radical prostatectomy, clinicians are probably able raters of life expectancy. In our radical prostatectomy series, even patients with the highest risk of competing mortality (age-adjusted Charlson score of 6 or higher, comprising only 4% of the sample) had a 10-year non-prostate cancer mortality rate of only 40% 4 Froehner M. Patient reported vs claims based measures of health for modeling life expectancy in men with prostate cancer. Letter. J Urol. 2021; 205: 1235-1236 Crossref Scopus (1) Google Scholar and the 50% level was not reached before narrowly 14 years. Complex tools requiring comprehensive data collection will probably not change routine decision making in candidates for radical prostatectomy regardless of their accuracy. If the risk classifications were, however, automatically calculated and readily available, there may be a different situation. Because of the huge sample size and the detailed information collected, the impressive data source used in this study 1 N. N. et al. Using an automated electronic health record score to estimate life expectancy in men diagnosed with prostate cancer in the Veterans Health Administration. Urology. 2021; ([in press]) Google Scholar should encourage further studies, for instance predicting 90-day mortality in vulnerable candidates for radical cystectomy.

Reporting of Comorbidities in Total Hip and Knee Arthroplasty Clinical Literature: A Systematic Review.

The effects of comorbid disease remain an area of interest. Concurrent diagnoses not only affect clinical outcomes but also affect health-care reimbursement. As the rate of arthroplasty increases, consistent risk stratification is imperative. Therefore, our aim was to ascertain how comorbidities have been reported in the recent total hip arthroplasty (THA) and total knee arthroplasty (TKA)-related literature; we also wanted to quantify the use of comorbidity scores for the assessment of comorbid disease in arthroplasty research. A systematic review of the recent THA and TKA literature that was published between January 1, 2019, and September 21, 2020, was performed using the PubMed and MEDLINE databases. Clinical studies that provided data on comorbidities were evaluated for method of comorbidity reporting. The prevalence of comorbidity reporting was assessed, and the manner of reporting was analyzed. Among 659 articles, a total of 207 studies (31.4%) reported comorbidities and met our inclusion criteria. Of the 207 studies that reported comorbidities, only 57% used a comorbidity index to report comorbid disease. Of all of the indices, the American Society of Anesthesiologists (ASA) Physical Status Classification System was the score that was most commonly used (TKA, 86.2%; THA, 83.3%). Additional scores were used at varying frequencies. For TKA, the scores included the Charlson Comorbidity Index (CCI) (15.5%); the New York Heart Association (NYHA) Functional Classification (3.4%); and the CCI-Deyo (adapted by Deyo et al.), the age-adjusted CCI, the Cumulative Illness Rating Scale (CIRS), and the Readmission Risk Assessment Tool (RRAT) (1.7% each). For THA, the scores included the CCI (16.7%), the Elixhauser Comorbidity Measure (ECM) (6.7%), and the CCI-Deyo (1.7%). Considering the impact of comorbid disease on outcomes, complications, and, ultimately, reimbursement, standardized risk stratification in arthroplasty is necessary. Current studies demonstrate inconsistent comorbidity reporting, making it challenging to further characterize the impact of comorbidities on outcomes. Future research should target the development of a standardized data-driven model for comorbidity assessment in the orthopaedic patient population.

CORR Insights®: Does a Prescription-based Comorbidity Index Correlate with the American Society of Anesthesiologists Physical Status Score and Mortality After Joint Arthroplasty? A Registry Study.

CORR Insights®: Does a Prescription-based Comorbidity Index Correlate with the American Society of Anesthesiologists Physical Status Score and Mortality After Joint Arthroplasty? A Registry Study.

Visual Factors From Patient Transfer During Clinic Visits Are Associated With Objective Measures of Operative Risk

Frailty, an important consideration for high-risk procedures, is usually assessed informally based on clinical gestalt—the “eye-ball test.” Although experienced surgeons are skilled at identifying high-risk patients, factors underlying their unstructured assessments are unknown. The objective of our study was to explore the visual factors that may be used in an “eye-ball test” and understand how these factors compare to objective measures of frailty, comorbidity, and risk.

Comorbidity indices in orthopaedic surgery: a narrative review focused on hip and knee arthroplasty.

Comorbidity indices currently used to estimate negative postoperative outcomes in orthopaedic surgery were originally developed among non-orthopaedic patient populations.While current indices were initially intended to predict short-term mortality, they have since been used for other purposes as well.As the rate of hip and knee arthroplasty steadily rises, understanding the magnitude of the effect of comorbid disease on postoperative outcomes has become increasingly more important.Currently, the ASA classification is the most commonly used comorbidity measure and is systematically recorded by the majority of national arthroplasty registries.Consideration should be given to developing an updated, standardized approach for comorbidity assessment and reporting in orthopaedic surgery, especially within the setting of elective hip and knee arthroplasty. Cite this article: EFORT Open Rev 2021;6:629-640. DOI: 10.1302/2058-5241.6.200124

#3113 Evaluating the PCL-C as a measure of trauma and PTSD symptoms in patients with functional neurological symptom disorder

AimsFunctional Neurological Symptom Disorder (FNSD) is common and disabling. Historically trauma was considered an essential aetiological factor, but the precise contribution of trauma to the disorder, and resulting disability, remains controversial. The PCL-C is a self-reported screening tool for PTSD symptoms based on DSM-IV criteria. A previous study in patients with FNSD demonstrated high scores on the PCL-C, with a reduction in scores following psychotherapy. However strong correlations with other psychological co-morbidities raised the possibility that the PCL-C may be capturing non-specific distress rather than indicators of previous traumatisation. The present study aimed to investigate (i) whether underlying factors measured by the PCL-C can distinguish specific trauma-memory-related symptoms from less specific emotion-regulation-related symptoms, (ii) the extent to which individual factors correlate with other psychopathology and health-related quality of life (HRQoL) measures and (iii) whether different factors change with psychotherapy, all in patients with FNSD.MethodsAn exploratory factor analysis of PCL-C responses from 473 FNSD patients pre-and post-psychotherapy was performed to generate1-4 factor models. The final factor model was determined through confirmatory factor analysis. Relationships between PCL-C factors, measures of comorbidities (depression, somatisation and anxiety) and HRQoL were assessed using regression analysis. Pre- and post-psychotherapy scores were compared.ResultsThe best model for the PCL-C comprised of two-factors: factor 1 (intrusive symptoms) explained 55.2% of the variance, whilst factor 2 (emotional dysregulation) explained 7.8% of the variance. Both factors reduced in severity after psychotherapy, but factor 2 reduced by more and correlated more strongly with a decrease in depression and anxiety than factor 1. Changes in depression, anxiety, somatic symptoms and mental HRQoL predicted 61.9% of the change in factor 2, but only 49.2% in factor 1. Improvements in mental HRQoL were strongly associated with a decrease in factor 2, but less so in factor 1.DiscussionThe factor analysis revealed the PCL-C represents two correlated but distinguishable symptom clusters in patients with FNSD: intrusive symptoms and emotional dysregulation. Both were elevated in our patient sample. The high level of intrusive symptoms suggests many patients with FNSD experience classical post-traumatic symptoms, which may indicate that subjective traumatic experiences contribute to pathogenesis and resulting disability. These symptoms showed some reduction with psychotherapy, but the greater reduction in emotional dysregulation symptoms and associated improvements in mental HRQoL suggest that psychotherapy may be more effective in reducing the burden of comorbidities and providing better coping strategies than in addressing core symptoms of the underlying disorder.