Using the age-adjusted Charlson comorbidity index to predict outcomes in emergency general surgery

St-Louis, Etienne; Iqbal, Sameena; Feldman, Liane S.; Sudarshan, Monisha; Deckelbaum, Dan; Razek, Tarek; Khwaja, Kosar

doi:10.1097/ta.0000000000000457

Cited by 88 publications

(66 citation statements)

References 19 publications

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“…Although age is related strongly to mortality, the presence of organ failure, including pulmonary disease, congestive cardiac failure, hypertension and renal failure, is an even stronger predictor of death. This reflects the role of ageing in accumulating co‐morbidity, as expressed in one study where the CACI was a good predictor of 30‐day mortality after emergency general surgery. The CCI has also been validated as a useful tool in morbidity and mortality prediction for the elderly with acute conditions.…”

Section: Predictors Of Mortality or Futilitymentioning

confidence: 97%

“…The Charlson Age–Co‐morbidity Index (CACI) was developed from the Charlson Co‐morbidity Index (CCI) to facilitate classification of co‐morbidities in longitudinal studies. The CACI weighs different medical conditions on a scale from 1 to 6; age is weighted +1 for every decade after 40 years.…”

Section: Screening and Assessment Of Frailtymentioning

confidence: 99%

“…The CACI weighs different medical conditions on a scale from 1 to 6; age is weighted +1 for every decade after 40 years. The CACI has been validated in several settings, including as a predictor of perioperative outcomes after acute surgical care. In a study of acute surgical care, but with most patients aged less than 65 years (i.q.r.…”

Section: Screening and Assessment Of Frailtymentioning

confidence: 99%

“…The CACI has been validated in several settings, including as a predictor of perioperative outcomes after acute surgical care. In a study of acute surgical care, but with most patients aged less than 65 years (i.q.r. 30–66 years), the authors showed that a higher CACI predicted both 30‐day mortality and critical care admission.…”

Section: Screening and Assessment Of Frailtymentioning

confidence: 99%

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Emergency general surgery in the geriatric patient

Desserud

Veen

Søreide

2015

British Journal of Surgery

144

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Background: Emergency general surgery in the elderly is a particular challenge to the surgeon in charge of their care. The aim was to review contemporary aspects of managing elderly patients needing emergency general surgery and possible alterations to their pathways of care.Methods: This was a narrative review based on a PubMed/MEDLINE literature search up until 15 September 2015 for publications relevant to emergency general surgery in the geriatric patient. Results:The number of patients presenting as an emergency with a general surgical condition increases with age. Up to one-quarter of all emergency admissions to hospital may be for general surgical conditions. Elderly patients are a particular challenge owing to added co-morbidity, use of drugs and risk of poor outcome. Frailty is an important potential risk factor, but difficult to monitor or manage in the emergency setting. Risk scores are not available universally. Outcomes are usually severalfold worse than after elective surgery, in terms of both higher morbidity and increased mortality. A care bundle including early diagnosis, resuscitation and organ system monitoring may benefit the elderly in particular. Communication with the patient and relatives throughout the care pathway is essential, as indications for surgery, level of care and likely outcomes may evolve. Ethical issues should also be addressed at every step on the pathway of care.Conclusion: Emergency general surgery in the geriatric patient needs a tailored approach to improve outcomes and avoid futile care. Although some high-quality studies exist in related fields, the overall evidence base informing perioperative acute care for the elderly remains limited.

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Section: Predictors Of Mortality or Futilitymentioning

confidence: 97%

Section: Screening and Assessment Of Frailtymentioning

confidence: 99%

Section: Screening and Assessment Of Frailtymentioning

confidence: 99%

Section: Screening and Assessment Of Frailtymentioning

confidence: 99%

See 2 more Smart Citations

Emergency general surgery in the geriatric patient

Desserud

Veen

Søreide

2015

British Journal of Surgery

144

View full text Add to dashboard Cite

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“…Importantly, these outcomes remained significant when emergency admissions were analysed separately to inpatient referrals (except the proportion of patients operated 5 or more days after admission), as well as after adjustment for key confounders. We used Charlson comorbidity index as a composite measure of morbidity; it has been validated as a mortality predictor in EGS . There were no significant differences in timing of the operation, resection rate, ICU admissions and use of TPN.…”

Section: Discussionmentioning

confidence: 99%

Impact of introduction of an acute surgical unit on management and outcomes of small bowel obstruction

Musiienko

Shakerian

Gorelik

et al. 2015

ANZ Journal of Surgery

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Background: The acute surgical unit (ASU) is a recently established model of care in Australasia and worldwide. Limited data are available regarding its effect on the management of small bowel obstruction. We compared the management of small bowel obstruction before and after introduction of ASU at a major tertiary referral centre. We hypothesized that introduction of ASU would correlate with improved patient outcomes. Methods: A retrospective review of prospectively maintained databases was performed over two separate 2-year periods, before and after the introduction of ASU. Data collected included demographics, co-morbidity status, use of water-soluble contrast agent and computed tomography. Outcome measures included surgical intervention, time to surgery, hospital length of stay, complications, 30-day readmissions, use of total parenteral nutrition, intensive care unit admissions and overall mortality. Results: Total emergency admissions to the ASU increased from 2640 to 4575 between the two time periods. A total of 481 cases were identified (225 prior and 256 after introduction of ASU). Mortality decreased from 5.8% to 2.0% (P = 0.03), which remained significant after controlling for confounders with multivariate analysis (odds ratio = 0.24, 95% confidence interval 0.08-0.73, P = 0.012). The proportion of surgically managed patients increased (20.9% versus 32.0%, P = 0.003) and more operations were performed within 5 days from presentation (76.6% versus 91.5%, P = 0.02). Fewer patients received water-soluble contrast agent (27.1% versus 18.4%, P = 0.02), but more patients were investigated with a computed tomography (70.7% versus 79.7%, P = 0.02). Conclusion:The ASU model of care resulted in decreased mortality, shorter time to intervention and increased surgical management. Overall complications rate and length of stay did not change.

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Prophylactic Ureteral Stent Placement vs No Ureteral Stent Placement During Open Colectomy

et al. 2018

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rate increased after RYGB to 28% at 1 year (21 patients), 31% at 5 years (23 patients), and 47% at 10 years (35 patients) (Figure 1).At 10 years after RYGB, the anemia rate in the cohort without bariatric specialist follow-up (n = 58) increased to 33 patients (57%), from 13 (22%) before surgery (P < .001). The rate of anemia in the cohort with bariatric specialist follow-up (n = 16) did not increase significantly after 10 years (3 [19%] vs 2 [13%]; P = .07) (Figure 2). Compared with patients with bariatric specialist follow-up, patients without bariatric specialist follow-up had significantly higher odds of anemia at 10 years (odds ratio, 6.1; 95% CI, 1.4-27.6; P = .02) after adjusting for preoperative anemia.Discussion | Long-term complications of RYGB, such as anemia, may go unrecognized by nonbariatric specialists. Causes include iron, vitamin B 12 , and folate deficiency; less common causes include copper, vitamin A, and selenium deficiency and bleeding marginal ulcers. We found high anemia rates 10 years after RYGB; these rates may reflect a mixed vitamin and mineral deficiency, because patients had normocytic anemia. Our study suggests that follow-up with bariatric specialists more than 5 years after surgery, rather than with specialists with no bariatric expertise, can decrease long-term anemia risk. This finding may demonstrate the bariatric specialist's specific understanding of the long-term risk for nutritional deficiency after RYGB and the importance of vitamin and mineral supplementation. All patients receiving iron supplements who still had anemia at 10 years were in the group without bariatric specialist follow-up (n = 11), a finding suggesting an inappropriate choice of treatment or inadequate follow-up. No similar effect of follow-up was observed for other long-term outcomes, such as excess weight loss and medication requirements.This study emphasizes the importance of long-term specialty-specific follow-up for bariatric surgery. The major limitation of this study was the size of the cohort with bariatric specialist follow-up, which may be too small to identify a significant difference in the 10-year anemia rates compared with preoperative rates. Nonetheless, the significant difference observed in the cohort without bariatric specialist follow-up suggests an opportunity for an intervention to improve follow-up and decrease anemia rates and other long-term complications. Long-term follow-up should be an integral part of bariatric programs, and additional studies are needed to identify potential barriers to successful follow-up. In the VA population, such barriers include distance from a bariatric center and lower socioeconomic status. We implemented a hub-andspoke model for bariatric care, including health care specialist education, in which the bariatric team communicates regularly with the patient's primary care clinician before and after surgery. 6 This model may prove to be an effective tool to overcome such barriers and improve outcomes.

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Using the age-adjusted Charlson comorbidity index to predict outcomes in emergency general surgery

Abstract: Prognostic study, level III.

Cited by 88 publications

References 19 publications

Emergency general surgery in the geriatric patient

Emergency general surgery in the geriatric patient

Impact of introduction of an acute surgical unit on management and outcomes of small bowel obstruction

Prophylactic Ureteral Stent Placement vs No Ureteral Stent Placement During Open Colectomy

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