Assessing and using comorbidity measures in elderly veterans with lower extremity amputations.
BACKGROUND
Understanding comorbidity prevalence and the effects of comorbidities in older veterans with lower extremity amputations may aid in assessing patient outcomes, resource use, and facility-level quality of care.


OBJECTIVE
To determine the degree to which adding outpatient to inpatient administrative data sources yields higher comorbidity prevalence estimates and improved explanatory power of models predicting 1-year mortality and to compare the Charlson/Deyo and Elixhauser comorbidity measures.


METHODS
A retrospective cohort study applying frequencies, cross-tabulations, and logistic regression models was conducted, including data from 2,375 veterans with lower extremity amputations. Comorbidity prevalence according to the Charlson/Deyo and Elixhauser measures, 1-year mortality rates, and standardized mortality ratios (SMRs) were analyzed.


RESULTS
Comorbidity prevalence estimates increased sharply for both the Charlson/Deyo and Elixhauser measures with the addition of data from multiple settings. The Elixhauser compared to the Charlson/Deyo generally yielded higher estimates but did not improve explanatory power for mortality. Modeling expected versus actual deaths produced varying SMRs across geographic regions but was not dependent on which measure or data sources were used.


CONCLUSIONS
Merging outpatient with inpatient data may reduce the under coding of comorbidities but does not enhance mortality prediction. Compared to the Charlson/Deyo, the Elixhauser has a more complete coding scheme for comorbid conditions, such as diabetes mellitus and peripheral vascular disease, important to addressing lower extremity amputation etiology.
Kurichi
Jibby E
JE
Department of Physical Medicine and Rehabilitation, University of Pennsylvania, Pennsylvania, Pa., USA.
Stineman
Margaret G
MG
Kwong
Pui L
PL
Bates
Barbara E
BE
Reker
Dean M
DM
D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D015331:Cohort Studies; D015897:Comorbidity; D003627:Data Interpretation, Statistical; D019992:Databases as Topic; D005568:Forms and Records Control; D017052:Hospital Mortality; D006801:Humans; D038801:International Classification of Diseases; D035002:Lower Extremity / Q000601:surgery; D015233:Models, Statistical; D015995:Prevalence; D012189:Retrospective Studies; D020379:Risk Adjustment; D014481:United States; D014728:Veterans