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. 2017 Oct;88(5):472-477.
doi: 10.1080/17453674.2017.1341243. Epub 2017 Jun 28.

Comorbidity does not predict long-term mortality after total hip arthroplasty

Erik Bülow  1   2 , Ola Rolfson  1   2 , Peter Cnudde  1   2   3 , Cecilia Rogmark  1   4 , Göran Garellick  1   2 , Szilárd Nemes  1   2
Affiliations

Comorbidity does not predict long-term mortality after total hip arthroplasty

Erik Bülow et al. Acta Orthop. 2017 Oct.

Abstract

Background and purpose - In-hospital death following total hip arthroplasty (THA) is related to comorbidity. The long-term effect of comorbidity on all-cause mortality is, however, unknown for this group of patients and it was investigated in this study. Patients and methods - We used data from the Swedish Hip Arthroplasty Register, linked to the National Patient Register from the National Board of Health and Welfare, for patients operated on with THA in 1999-2012. We identified 120,836 THAs that could be included in the study. We evaluated the predictive power of the Charlson and Elixhauser comorbidity indices on mortality, using concordance indices calculated after 5, 8, and 14 years after THA. Results - All comorbidity indices performed poorly as predictors, in fact worse than a base model with age and sex only. Elixhauser was, however, the least bad choice and it predicted mortality with concordance indices 0.59, 0.58, and 0.56 for 5, 8, and 14 years after THA. Interpretation - Comorbidity indices are poor predictors of long-term mortality after THA.

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Figures

Figure 1.
Figure 1.
Flow chart describing inclusion criteria for study population.
Figure 2.
Figure 2.
The predictive power of each comorbidity index summarized by the concordance index over time (upper panel). Absolute values are low and decreasing. Time-dependent ROC curves are shown below for 30, 90, and 365 days after THA. The relative order among the comorbidity indices was preserved throughout the entire period but their absolute differences were small.
Figure 3.
Figure 3.
Concordance indices as a measure of predictive power for models with the 3 comorbidity indices, with and without inclusion of age and sex. A base model with age and sex alone was used as a reference. The confi dence intervals were based on non-parametric bootstrapping. They were all narrow, due to the large sample size.
See this image and copyright information in PMC

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