Systematic Review
The Utility of Comorbidity Indices in Assessing Head and Neck Surgery Outcomes: A Systematic Review
Kavya Pai BS,
Carla Baaklini BS,
Claudia I. Cabrera MD, MS,
Akina Tamaki MD,
Nicole Fowler MD,
Nicole Maronian MD,
Kavya Pai BS
University of Toledo College of Medicine and Life Sciences, Toledo, Ohio, U.S.A.
Search for more papers by this authorCarla Baaklini BS
Northeast Ohio Medical University, Rootstown, Ohio, U.S.A.
Search for more papers by this authorClaudia I. Cabrera MD, MS
Department of Otolaryngology-Head and Neck Surgery, University Hospitals Case Medical Center, Cleveland, Ohio, U.S.A.
Case Western Reserve University School of Medicine, Cleveland, Ohio, U.S.A.
Search for more papers by this authorAkina Tamaki MD
Department of Otolaryngology-Head and Neck Surgery, University Hospitals Case Medical Center, Cleveland, Ohio, U.S.A.
Case Western Reserve University School of Medicine, Cleveland, Ohio, U.S.A.
Search for more papers by this authorNicole Fowler MD
Department of Otolaryngology-Head and Neck Surgery, University Hospitals Case Medical Center, Cleveland, Ohio, U.S.A.
Case Western Reserve University School of Medicine, Cleveland, Ohio, U.S.A.
Search for more papers by this authorCorresponding Author
Nicole Maronian MD
Department of Otolaryngology-Head and Neck Surgery, University Hospitals Case Medical Center, Cleveland, Ohio, U.S.A.
Case Western Reserve University School of Medicine, Cleveland, Ohio, U.S.A.
Send correspondence to Nicole Maronian, MD, Department Chair of Otolaryngology-Head and Neck Surgery, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, LKS 5045, Cleveland, OH 44106. E-mail: [email protected]
Search for more papers by this authorKavya Pai BS,
Carla Baaklini BS,
Claudia I. Cabrera MD, MS,
Akina Tamaki MD,
Nicole Fowler MD,
Nicole Maronian MD,
Kavya Pai BS
University of Toledo College of Medicine and Life Sciences, Toledo, Ohio, U.S.A.
Search for more papers by this authorCarla Baaklini BS
Northeast Ohio Medical University, Rootstown, Ohio, U.S.A.
Search for more papers by this authorClaudia I. Cabrera MD, MS
Department of Otolaryngology-Head and Neck Surgery, University Hospitals Case Medical Center, Cleveland, Ohio, U.S.A.
Case Western Reserve University School of Medicine, Cleveland, Ohio, U.S.A.
Search for more papers by this authorAkina Tamaki MD
Department of Otolaryngology-Head and Neck Surgery, University Hospitals Case Medical Center, Cleveland, Ohio, U.S.A.
Case Western Reserve University School of Medicine, Cleveland, Ohio, U.S.A.
Search for more papers by this authorNicole Fowler MD
Department of Otolaryngology-Head and Neck Surgery, University Hospitals Case Medical Center, Cleveland, Ohio, U.S.A.
Case Western Reserve University School of Medicine, Cleveland, Ohio, U.S.A.
Search for more papers by this authorCorresponding Author
Nicole Maronian MD
Department of Otolaryngology-Head and Neck Surgery, University Hospitals Case Medical Center, Cleveland, Ohio, U.S.A.
Case Western Reserve University School of Medicine, Cleveland, Ohio, U.S.A.
Send correspondence to Nicole Maronian, MD, Department Chair of Otolaryngology-Head and Neck Surgery, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, LKS 5045, Cleveland, OH 44106. E-mail: [email protected]
Search for more papers by this authorEditor's Note: This Manuscript was accepted for publication on October 06, 2021.
The authors have no funding, financial relationships, or conflicts of interest to disclose.
Abstract
Objective
To evaluate the utility of comorbidity index (CI) scores in predicting outcomes in head and neck surgery (HNS). The CIs evaluated were the Charlson Comorbidity Index (CCI), Elixhauser Comorbidity Index (ECI), Kaplan-Feinstein Index (KFI), American Society of Anesthesiologists Physical Status (ASA-PS), Adult Comorbidity Evaluation-27 (ACE-27), National Cancer Institute Comorbidity Index (NCI-CI), and the Washington University Head and Neck Comorbidity Index (WUHNCI).
Methods
We report a systematic review according to the 2009 Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Electronic databases (PubMed, Cochrane, and Embase) and manual search of bibliographies identified manuscripts addressing how CI scores related to HNS outcomes.
Results
A total of 116 studies associated CI scores with HNS outcomes. CIs were represented in the literature as follows: ASA-PS (70/116), CCI (39/116), ACE-27 (24/116), KFI (7/116), NCI-CI (3/116), ECI (2/116), and WUHNCI (1/116). The most frequently cited justification for calculating each CI (if provided) was: CCI for its validation in other studies, ACE-27 for its utility in cancer patients, and ECI for its comprehensive design. In general, the CCI and ACE-27 were predictive of mortality in HNS. The ECI was most consistent in predicting >1-year mortality. The ACE-27 and KFI were most consistent in predicting medical complications.
Conclusion
Despite inconsistencies in the literature, CIs provide insights into the impact of comorbidities on outcomes in HNS. These scores should be employed as an adjunct in the preoperative assessment of HNS patients. Comparative studies are needed to identify indices that are most reliable in predicting HNS outcomes.
Level of Evidence
NA Laryngoscope, 132:1388–1402, 2022
Supporting Information
| Filename | Description |
|---|---|
| lary29905-sup-0001-Tables.docxWord 2007 document , 221.7 KB | Supporting Table 1 Search strategy with Boolean operators. Supporting Table 2. Quality of evidence and risk of bias of each included article. |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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