Mortality Prediction in a Vertebral Compression Fracture Population: the ASA Physical Status Score versus the Charlson Comorbidity Index

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Fig. 1
Survival Plots for non-operative Patients.
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Fig. 2
Survival Plots for Operative Patients.

Table 1

ASA Physical Status (PS) Classification System.

	Preoperative Health Status	Comments
ASA 1	Normal, healthy patient	No organic, physiologic, or psychiatric disturbance, excludes the very young and very old, healthy with good exercise tolerance
ASA 2	Patients with mild systemic disease	No functional limitations; has a well-controlled disease of one body system, controlled hypertension or diabetes without systemic effects, cigarette smoking without COPD, mild obesity, pregnancy
ASA 3	Patients with severe systemic disease	Some functional limitation; has a controlled disease of more than one body system or one major system, no immediate danger of death, controlled congestive heart failure(CHF), stable angina, old heart attack, poorly controlled hypertensions, morbid obesity, chronic renal failure, bronchospastic disease with intermittent symptoms
ASA 4	Patients with severe systemic disease that is a constant threat to life	Has at least one severe disease that is poorly controlled or at end stage, possible risk of death, unstable angina, symptomatic COPD, symptomatic CHF, hepatorenal failure
ASA 5	Moribund patients who are not expected to survive without surgery	Not expected to survive > 24 hours without surgery; imminent risk of death; multiorgan failure, sepsis syndrome with hemodynamic instability, hypothermia, poorly controlled coagulopathy
ASA 6	A declared brain-dead patient whose organs are being removed for donor purposes

Table 2

Comorbidity Weights for Calculation of the Charlson Comorbidity Index.

Weighted Score	Condition	Weighted Score	Condition
1	Myocardial infarct	2	Hemiplegia
1	Congestive heart failure	2	Moderate or severe renal disease
1	Peripheral vascular disease	2	Diabetes with end organ damage
1	Cerebrovascular disease	2	Any tumor
1	Dementia	2	Leukemia
1	Chronic pulmonary disease	2	Lymphoma
1	Connective tissue disease	3	Liver disease, moderate or severe
1	Ulcer disease	6	Metastatic solid tumor
1	Liver disease, mild	6	AIDS
1	Diabetes

Table 3

Log Rank Tests for Operative versus Non-operative Patients.

The CCI correlation to mortality was not significant (p= 0.2027) for the surgery population but highly significant (p = 0.0161) in the non-operative population. The ASA Score correlation to mortality was significant (p= 0.0150) for the surgery population while the test was not significant (p = 0.1439) in the non-operative population.

Table 4

Total Population Morbidity Scores.

Table 5

Non-Operative Morbidity Scores.

Table 6

Operative Morbidity Scores.

Table 7

Comparison of Mean Morbidity Scores.