Identifying co-morbidity in surgical patients using administrative data with the Royal College of Surgeons Charlson Score
Identifying co-morbidity in surgical patients using administrative data with the Royal College of Surgeons Charlson Score
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DOI：
10.1002/bjs.6930
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发表时间：
2010-05-01
影响因子：
9.6
通讯作者：
van der Meulen, J. H.
中科院分区：
文献类型：
--
作者：
Armitage, J. N.;van der Meulen, J. H.
背景：手术结果受合并症的影响。皇家外科医师学会（RCS）共病共识小组的召开是为了改进现有的国际疾病分类第十版行政数据中确定共病的工具。方法：RCS Charlson评分采用一种增强国际可转移性的编码理念，避免将并发症误诊为合并症。该评分在腹主动脉瘤（AAA）修复、主动脉瓣置换术、全髋关节置换术和经尿道前列腺切除术的英国医院事件统计数据中得到验证。结果：除AAA外，合并合并的患者年龄较大，入院的可能性大于未合并合并的患者。所有合并症患者住院时间更长，需要更多的强化护理，住院死亡率和1年死亡率更高。纳入RCS Charlson评分的多变量预后模型比仅依赖于年龄、性别、入院方式（选择性或急诊）和前一年急诊入院次数的模型具有更好的歧视性。结论：RCS Charlson评分至少可以识别英国手术患者的合并症以及现有的器械。鉴于其明确的编码理念，它可以用作国际比较的合并症评分工具。
Background: Surgical outcomes are influenced by co-morbidity. The Royal College of Surgeons (RCS) Co-morbidity Consensus Group was convened to improve existing instruments that identify co-morbidity in International Classification of Diseases tenth revision administrative data.Methods: The RCS Charlson Score was developed using a coding philosophy that enhances international transferability and avoids misclassifying complications as co-morbidity. The score was validated in English Hospital Episode Statistics data for abdominal aortic aneurysm (AAA) repair, aortic valve replacement, total hip replacement and transurethral prostate resection.Results: With exception of AAA, patients with co-morbidity were older and more likely to be admitted as an emergency than those without. All patients with co-morbidity stayed longer in hospital, required more augmented care, and had higher in-hospital and I-year mortality rates. Multivariable prognostic models incorporating the RCS Charlson Score had better discriminatory power than those that relied only on age, sex, admission method (elective or emergency) and number of emergency admissions in the preceding year.Conclusion: The RCS Charlson Score identifies co-morbidity in surgical patients in England at least as well as existing instruments. Given its explicit coding philosophy, it may be used as a co-morbidity scoring instrument for international comparisons.