Inconsistent, Low Comorbidity Reporting in Arthroplasty Studies?

Given their impact, it may be a bit of a surprise to some that diabetes, cardiac issues and the like are inconsistently reported in the total hip and total knee arthroplasty (THA, TKA) literature.

To quantify the extent of this issue, a team from the Cleveland Clinic Foundation in Ohio set out to put numbers to the problem. Their systematic review, “Reporting of Comorbidities in Total Hip and Knee Arthroplasty Clinical Literature,” appears in the September 2021 edition of JBJS Reviews.

The Adult Joint Reconstructive Surgery Research Program Director at Cleveland Clinic, Nicolas S. Piuzzi, M.D., discussed their work with OTW, saying, “Considering the impact that comorbidities pose on outcomes, complications, and ultimately, reimbursement after THA and TKA, the reporting of comorbidities is essential to standardized risk stratification.”

“The use of comorbidity scores in arthroplasty research provides a means for systematically estimating perioperative risks and the association between comorbidities and outcomes. As consistent risk stratification is imperative to enhancing value of care, we intended to ascertain how comorbidities have been reported in the recent THA- and TKA-related literature.”

Delving into the THA and TKA literature published between January 1, 2019, and September 21, 2020, the researchers looked for clinical studies containing data on comorbidities and highlighted the method of comorbidity reporting.

Initially locating 659 articles, the authors ultimately found that a total of 207 studies (31.4%) reported comorbidities and met their inclusion criteria. “Of the 207 studies that reported comorbidities, only 57% used a comorbidity index to report comorbid disease,” they wrote.

“Of all the indices, the American Society of Anesthesiologists 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 (15.5%); the New York Heart Association Functional Classification (3.4%); and the Charlson Comorbidity Index-Deyo (adapted by Deyo et al.), the age-adjusted Charlson Comorbidity Index, the Cumulative Illness Rating Scale, and the Readmission Risk Assessment Tool (1.7% each). For THA, the scores included the Charlson Comorbidity Index (16.7%), the Elixhauser Comorbidity Measure (6.7%), and the Charlson Comorbidity Index-Deyo (1.7%).”

“Overall,” said Dr. Piuzzi to OTW, “our study found inconsistent and low comorbidity reporting in the recent arthroplasty literature. Although several studies used the American Society of Anesthesiologists class and the Charlson Comorbidity Index to describe comorbid disease, evidence suggests that these tools do not sufficiently characterize the complex patient population in orthopaedic arthroplasty studies.”

“Future research should target the development of a standardized data-driven model for comprehensive comorbidity assessment in the orthopaedic patient population to allow accurate reporting and consistent risk stratification.”