Could ASA and Charlson Comorbidity Index Scores Help the Current Comorbidities Stratification in Non-surgical Knee Osteoarthritis Multimodal Pain Management?

Abstract

Non-surgical management of knee osteoarthritis emphasizes on multimodal approach according to patients subphenotypes (with or without comorbidities). Surgical treatment outcomes data suggest the role of ASA and Charlson Comorbidity Index (CCI) scores in the field. There are no comparative data on ASA and CCI stratification in non-surgical knee osteoarthritis pain management, which is the aim of our study.

Eighty ASA 1–3 in-hospital patients, aged ≥ 36, treated for symptomatic chronic knee osteoarthritis with implemented intra-articular Betamethasone (7 mg/ml) or Hyaluronic acid (30 mg/2 ml), followed by as needed Dexketoprofen 50 mg i.v. or Paracetamol 1.0 g i.v., along with recommended 2 weeks (10 working days) exercise-based physiotherapy programme were examined retrospectively. Data regarding demographics, comorbidities, ASA low-risk(1–2)/high-risk(3), CCI low-risk(0–1/0–2)/high-risk(≥ 2/≥ 3) scoring subgroups, effusions, WBC, ESR, vital signs, clinical laboratory parameters, adverse events, and analgesic consumptions were collected as well. We tested the effect of different ASA and CCI scores on analgesic consumption (primary outcomes), and the effect of implemented risk-adjusted multimodal analgesia on subsequent participation or non-participation in the physiotherapy programme (secondary outcomes). Among all outcomes variables, ASA and CCI stratification confirmed only the higher age and ESR determinants in both the high-risk ASA 3 and high-risk CCI $ ≥ 2 subgroups, as well as more Hyaluronic acid applications in the elderly. The participants in the physiotherapy programme were mainly low-risk patients who received significantly more intra-articular Hyaluronic acid than Betamethasone. The ASA and CCI scores could help current (yes/no comorbidities) decision-making by implementing risk-adjusted pain management, emphasizing on severity rather than the type of comorbid conditions in non-surgical knee osteoarthritis population.