Characterizing Comorbidities in Total Joint Arthroplasty in a Safety-Net Hospital Using Age-Adjusted Charlson Comorbidity Index.

Abstract

Background: The joint arthroplasty population has a high number of comorbidities at the time of surgery, which increases the cost of care per episode. The goal of this study was to analyze the distribution of comorbid diseases in patients who have undergone total joint arthroplasty at our institution, which serves the poorest congressional district in the United States. We hypothesized that patients in an urban safety-net hospital would have higher comorbidity rates and higher Charlson Comorbidity Indices and that this would suggest the need for improved risk stratification in payment systems.

Methods: A retrospective analysis was conducted by reviewing consecutive patients who underwent total joint arthroplasty between 2008 and 2023 (N = 3011). Relevant comorbidities were used to calculate the age-adjusted Charlson Comorbidity Index. From this, we determined the score distribution and identified the most frequent conditions. Descriptive statistical analysis was conducted to determine the mean and variance.

Results: Within the patient population concerning CCI scores, 10.93% of the patient population scored 0, 22.42% scored 1, 27.33% scored 2, 20.86% scored 3, 10.73% scored 4, and 7.74% scored 5 and above. The mean CCI score was 2.25 ± 1.50. The most frequently occurring comorbid conditions according to hospital criteria in this population were hypertension (N = 2078, 69.01%), obesity (N = 1366, 45.37%), diabetes (N = 906, 30.09%), and anemia (N = 694, 23.05%). A total of 19.10% of patients were current smokers. Of all TJA patients, 96.9% had at least 1 comorbidity.

Conclusion: The major finding from this retrospective analysis revealed the presence of a high incidence of comorbidities in the our health system's total joint arthroplasty population. We confirmed that this closed urban population is a unique subset of at-risk individuals who are undergoing TJA, which may increase their complication rates. Consideration for proper risk stratification in communities like this need to be considered.