Predicting In-Hospital Mortality in Patients Undergoing Complex Gastrointestinal Surgery

Abstract

Patients: Adult patients (Ն18 years) hospitalized with a primary or secondary procedure of gastric, hepatic, or pancreatic resection between 2002 and 2007. Main Outcome Measures: Predicting in-hospital mortality using the 4 comorbidity algorithms. Logistic regression analyses were used and C statistics were calculated to assess the performance of the indexes. Risk adjustment methods were then compared. Results: In our study, we identified 46 395 gastric resections, 18 234 hepatic resections, and 15 443 pancreatic re-sections. Predicted in-hospital mortality rates according to the adjustment methods agreed for 43.8% to 74.6% of patients. In all types of resections, the APR-DRGs and Disease Staging algorithms predicted in-hospital mortality better than the Charlson/Deyo and Elixhauser indexes (PϽ.001). Compared with the Charlson/Deyo algorithm, the Elixhauser index was of higher accuracy in gastric resections (0.847 vs 0.792), hepatic resections (0.810 vs 0.757), and pancreatic resections (0.811 vs 0.741) (PϽ.001 for all comparisons). Higher accuracy of the Elixhauser algorithm compared with the Charlson/Deyo algorithm was not affected by diagnosis rank, multiple surgeries, or exclusion of transplant patients. Conclusions: Different comorbidity algorithms were validated in the surgical setting. The Disease Staging and APR-DRGs algorithms were highly accurate. For commonly used algorithms such as Charlson/Deyo and Elixhauser, the latter showed higher accuracy.

The Elixhauser Comorbidity Method Outperforms the Charlson Index in Predicting Inpatient Death After Orthopaedic Surgery

“…Although differences in the AUC values between the two comorbidity-based measures were small, it has been noted that even slight improvements in the AUC for such indexes can translate into quantifiable reductions in confounding bias [46]. Overall, the AUC values for inpatient mortality for the Charlson and Elixhauser comorbidity-based measures in our study were comparable to or slightly higher than those described in other patient populations [6,18,27,52]. Consistent with a study by Nikkel et al [39] in patients with hip fractures, the Elixhauser weight loss or malnutrition comorbidity was the major factor influencing mortality.…”

“…However, in line with the study by Gordon et al [17] looking at the influence of the Elixhauser and Charlson measures on reoperations after THA, the predictive accuracy of both models to detect adverse events was poor (AUC values \ 0.70). An AUC value approximating 0.70 is considered acceptable for discrimination and validation of methods for ongoing use [18]; we therefore could not validate the Charlson or Elixhauser measures in terms of predicting perioperative complications after major orthopaedic surgery. There may be something beyond measurable comorbidities that is yet unaccounted for in orthopaedic inpatient morbidity.…”

“…First reported in 1987 to predict 1-year mortality [5], this index subsequently was adapted for use with administrative databases [9]. The Elixhauser measure [12], a more recent model including 31 conditions, is believed to be a better predictor of mortality in patients with cardiac, gastrointestinal, hepatobiliary, and oncologic conditions [6,18,27,52]. Several prevalent comorbidities such as hypertension, obesity, weight loss, and psychiatric disorders that are included in the Elixhauser model are not included in the Charlson model [12].…”

Improving the outcomes in gastric cancer surgery

“…The Charlson comorbidity index (CCI) was established as a method for classifying comorbid conditions that determine risks of mortality [10] . CCI was later identified and validated in a surgical setting for prediction of mortality risk in patients undergoing complex gastrointestinal surgery [11] . It was shown in octo-and nonogenarians who underwent radical gastrectomies that these elderly patients had higher morbidity and mortality rates, and this was associated with CCI ≥ 5 [12] .…”

A Comparison of the Charlson and Elixhauser Comorbidity Measures to Predict Inpatient Mortality After Proximal Humerus Fracture

“…11 The Elixhauser comorbidity measure, a newer approach consisting of 30 conditions, has been identified as a better predictor of mortality in patients hospitalized for cardiac, oncologic, hepatobiliary, and gastrointestinal disease and more recently among patients undergoing major orthopaedic surgery. [16][17][18][19][20][21] Several comorbidities that are highly prevalent in orthopaedic trauma patients are encompassed in one but not the other risk adjustment method. For instance, hypertension, obesity, weight loss, and depression are not included in the Charlson index, whereas stroke and myocardial infarction are not contained in the Elixhauser model.…”