Patient demographic information, hospital characteristics, and inpatient outcomes such as discharge disposition and hospital length of stay also were collected. A maximum of seven medical diagnoses and four procedures were gathered and coded with the use of ICD-9-CM codes. Sample data then were weighted to produce annual estimates of inpatient care. The NHDS is an annual probability sample survey of discharges from nonfederal, general, and short-stay hospitals in the United States. We therefore determined whether there was a difference in the accuracy of the Charlson and Elixhauser comorbidity-based measures in predicting (1) in-hospital mortality after major orthopaedic surgery, (2) in-hospital adverse events, and (3) nonroutine discharge.Īll data were extracted from the National Hospital Discharge Survey (NHDS) database. Several prevalent comorbidities such as hypertension, obesity, weight loss, and psychiatric disorders that are included in the Elixhauser model are not included in the Charlson model. The Elixhauser measure, a more recent model including 31 conditions, is believed to be a better predictor of mortality in patients with cardiac, gastrointestinal, hepatobiliary, and oncologic conditions. First reported in 1987 to predict 1-year mortality, this index subsequently was adapted for use with administrative databases. The Charlson Comorbidity Index encompasses 19 medical conditions and is the most widely used comorbidity risk adjustment model in orthopaedic surgery. Large administrative inpatient databases have been used to assess the effect of baseline comorbidity status on surgical care outcomes targeted in pay-for-performance initiatives such as mortality, morbidity, and discharge disposition. Furthermore, inadequate comorbidity risk-adjustment might penalize practitioners and hospitals that care for the sickest patients. Selecting appropriate risk adjustment models can help hospitals contain costs while ensuring high levels of quality. Several models for estimating risk based on coded comorbidities are currently in use for orthopaedic patients, but there is no consensus regarding the optimal approach. Preoperative risk assessment can help with decision-making and management strategies. Patients undergoing orthopaedic surgery often have multiple coexisting medical conditions (comorbidities).

Spss code elixhauser comorbid score