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Response to Letter to the Editor: ‘Use of preoperative comorbidity scores to predict mortality after total arthroplasty’

  • M.C.S. Inacio
    Correspondence
    Address correspondence and reprint requests to: M.C.S. Inacio, Quality Use of Medicines and Pharmacy Research Centre, Medicine and Device Surveillance Centre of Research Excellence, Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia, GPO Box 2471, Adelaide 5001, South Australia, Australia.
    Affiliations
    Quality Use of Medicines and Pharmacy Research Centre, Medicine and Device Surveillance Centre of Research Excellence, Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia, GPO Box 2471, Adelaide 5001, South Australia, Australia
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  • N.L. Pratt
    Affiliations
    Quality Use of Medicines and Pharmacy Research Centre, Medicine and Device Surveillance Centre of Research Excellence, Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia, GPO Box 2471, Adelaide 5001, South Australia, Australia
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  • E.E. Roughead
    Affiliations
    Quality Use of Medicines and Pharmacy Research Centre, Medicine and Device Surveillance Centre of Research Excellence, Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia, GPO Box 2471, Adelaide 5001, South Australia, Australia
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  • S.E. Graves
    Affiliations
    Australian Orthopaedic Association, National Total Joint Replacement Registry, Level 6, Bice Building, Royal Adelaide Hospital, The University of Adelaide, Adelaide 5005, South Australia, Australia
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Open ArchivePublished:September 08, 2016DOI:https://doi.org/10.1016/j.joca.2016.09.003
      Dear editors,
      Thank you for the opportunity to reply to Xue et al.'s letter regarding our recent manuscript. We appreciate Xue et al.'s interest in our study and agree that a series of pre, intra, and post-operative factors are associated with a higher risk of mortality after joint replacement surgery. We do not dispute the importance of these factors and their impact on death. Our study did not intend to identify factors associated with mortality after surgery but instead evaluated and compared the ability of three widely used co-morbidity measures' to predict mortality.
      • Inacio M.C.
      • Pratt N.L.
      • Roughead E.E.
      • Graves S.E.
      Evaluation of three co-morbidity measures to predict mortality in patients undergoing total joint arthroplasty.
      We examined the Charlson, Elixhauser, and RxRisk-V co-morbidity measures, which use pre-operative patients' information, and compared their death predictive ability, so we could provide advice on which of these three existing measures performed better in a patient population where no consensus regarding this question existed.
      We would like to clarify that we did not suggest co-morbidity measures provide exact mortality predictions. We understand the limitations of prognostic models and only compare our models and offer interpretation of our findings regarding their overall performance. Our review of these measures aimed to provide information on their performance in predicting death so that the best measure could be chosen for studies of joint replacement patients.

      Authors' contributions

      Drafting response letter: MCSI.

      Final review and approval

      MCSI, NLP, EER, SEG.

      Conflict of interest

      None of the authors have any conflict of interest.

      Acknowledgements

      None.

      Reference

        • Inacio M.C.
        • Pratt N.L.
        • Roughead E.E.
        • Graves S.E.
        Evaluation of three co-morbidity measures to predict mortality in patients undergoing total joint arthroplasty.
        Osteoarthritis Cartilage. 2016; 24: 1718-1726https://doi.org/10.1016/j.joca.2016.05.006

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      • Use of preoperative comorbidity scores to predict mortality after total arthroplasty
        Osteoarthritis and CartilageVol. 25Issue 1
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          With great interest we read the recent article by Inacio et al.1 comparing performance of three comorbidity measures to predict 90-day and 1-year mortality after total hip and knee arthroplasty in a cohort of elderly patients. They showed that the Elixhauser and Charlson comorbidity scores had similar performance for postoperative mortality prediction, but performed better than the RxRisk-V comorbidity score. Furthermore, a combined model with comorbidities identified by three comorbidity scores was the best postoperative mortality prediction model.
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