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Association of comorbidities with postoperative in-hospital mortality: a retrospective cohort study.

Kork F, Balzer F, Krannich A, Weiss B, Wernecke KD, Spies C - Medicine (Baltimore) (2015)

Bottom Line: However, these scores have never been compared in a broad surgical population.The CCI was superior to the ASA PS in predicting postoperative mortality (AUROCCCI 0.865 vs AUROCASAPS 0.833, P < 0.001).It is capable of identifying those patients at especially high risk and may help reduce postoperative mortality.

View Article: PubMed Central - PubMed

Affiliation: From the Department of Anesthesiology and Intensive Care Medicine (FK, FB, BW, CS), Campus Charité Mitte and Campus Virchow-Klinikum; Department of Biostatistics (AK), Coordination Centre for Clinical Trials, Campus Virchow-Klinikum; and Department of Biometry and SOSTANA GmbH (KDW), Charité-University Medicine Berlin, Berlin, Germany.

ABSTRACT
The purpose of this article is to evaluate the American Society of Anesthesiologists Physical Status (ASA PS) and the Charlson comorbidity index (CCI) for the prediction of postoperative mortality. The ASA PS has been suggested to be equally good as the CCI in predicting postoperative outcome. However, these scores have never been compared in a broad surgical population. We conducted a retrospective cohort study in a German tertiary care university hospital. Predictive accuracy was compared using the area under the receiver-operating characteristic curves (AUROC). In a post hoc approach, a regression model was fitted and cross-validated to estimate the association of comorbidities and intraoperative factors with mortality. This model was used to improve prediction by recalibrating the CCI for surgical patients (sCCIs) and constructing a new surgical mortality score (SMS). The data of 182,886 patients with surgical interventions were analyzed. The CCI was superior to the ASA PS in predicting postoperative mortality (AUROCCCI 0.865 vs AUROCASAPS 0.833, P < 0.001). Predictive quality further improved after recalibration of the sCCI and construction of the new SMS (AUROCSMS 0.928 vs AUROCsCCI 0.896, P < 0.001). The SMS predicted postoperative mortality especially well in patients never admitted to an intensive care unit. The newly constructed SMS provides a good estimate of patient's risk of death after surgery. It is capable of identifying those patients at especially high risk and may help reduce postoperative mortality.

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Related in: MedlinePlus

Flow chart of data acquisition leading to analyzed cases.
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Figure 1: Flow chart of data acquisition leading to analyzed cases.

Mentions: We identified 230,034 electronically accessible anesthesia records during the study period, out of which 34,345 were anesthesia records of the same patient who underwent surgery >1 time. The data of 2827 outpatient cases and 10,010 cases with incomplete records were excluded from the analysis. In total, the data of 182,886 cases were analyzed (Figure 1). Patients’ median age was 47 and 47% of the study population was female. The most frequent comorbidities were malignancy of any kind (13%), diabetes without complication (10.9%), and renal disease (6.8%). The majority of patients underwent elective surgery (78.1%); the mean duration of the surgical procedure was 61 minutes (IQR 25–116 minutes). Most patients underwent traumatology/orthopedic surgery (18.4%), general surgery (15.5%), and gynecological surgery (10.2%; Table 1). A total of 2301 patients died during their hospital stay (1.3%; Table 2) and the median hospital length of stay was 5 days (IQR 3–10 days). Survivors had a median hospital length of stay of 5 days (IQR 3–10 days) and nonsurvivors of 25 days (IQR 11–51 days).


Association of comorbidities with postoperative in-hospital mortality: a retrospective cohort study.

Kork F, Balzer F, Krannich A, Weiss B, Wernecke KD, Spies C - Medicine (Baltimore) (2015)

Flow chart of data acquisition leading to analyzed cases.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4554144&req=5

Figure 1: Flow chart of data acquisition leading to analyzed cases.
Mentions: We identified 230,034 electronically accessible anesthesia records during the study period, out of which 34,345 were anesthesia records of the same patient who underwent surgery >1 time. The data of 2827 outpatient cases and 10,010 cases with incomplete records were excluded from the analysis. In total, the data of 182,886 cases were analyzed (Figure 1). Patients’ median age was 47 and 47% of the study population was female. The most frequent comorbidities were malignancy of any kind (13%), diabetes without complication (10.9%), and renal disease (6.8%). The majority of patients underwent elective surgery (78.1%); the mean duration of the surgical procedure was 61 minutes (IQR 25–116 minutes). Most patients underwent traumatology/orthopedic surgery (18.4%), general surgery (15.5%), and gynecological surgery (10.2%; Table 1). A total of 2301 patients died during their hospital stay (1.3%; Table 2) and the median hospital length of stay was 5 days (IQR 3–10 days). Survivors had a median hospital length of stay of 5 days (IQR 3–10 days) and nonsurvivors of 25 days (IQR 11–51 days).

Bottom Line: However, these scores have never been compared in a broad surgical population.The CCI was superior to the ASA PS in predicting postoperative mortality (AUROCCCI 0.865 vs AUROCASAPS 0.833, P < 0.001).It is capable of identifying those patients at especially high risk and may help reduce postoperative mortality.

View Article: PubMed Central - PubMed

Affiliation: From the Department of Anesthesiology and Intensive Care Medicine (FK, FB, BW, CS), Campus Charité Mitte and Campus Virchow-Klinikum; Department of Biostatistics (AK), Coordination Centre for Clinical Trials, Campus Virchow-Klinikum; and Department of Biometry and SOSTANA GmbH (KDW), Charité-University Medicine Berlin, Berlin, Germany.

ABSTRACT
The purpose of this article is to evaluate the American Society of Anesthesiologists Physical Status (ASA PS) and the Charlson comorbidity index (CCI) for the prediction of postoperative mortality. The ASA PS has been suggested to be equally good as the CCI in predicting postoperative outcome. However, these scores have never been compared in a broad surgical population. We conducted a retrospective cohort study in a German tertiary care university hospital. Predictive accuracy was compared using the area under the receiver-operating characteristic curves (AUROC). In a post hoc approach, a regression model was fitted and cross-validated to estimate the association of comorbidities and intraoperative factors with mortality. This model was used to improve prediction by recalibrating the CCI for surgical patients (sCCIs) and constructing a new surgical mortality score (SMS). The data of 182,886 patients with surgical interventions were analyzed. The CCI was superior to the ASA PS in predicting postoperative mortality (AUROCCCI 0.865 vs AUROCASAPS 0.833, P < 0.001). Predictive quality further improved after recalibration of the sCCI and construction of the new SMS (AUROCSMS 0.928 vs AUROCsCCI 0.896, P < 0.001). The SMS predicted postoperative mortality especially well in patients never admitted to an intensive care unit. The newly constructed SMS provides a good estimate of patient's risk of death after surgery. It is capable of identifying those patients at especially high risk and may help reduce postoperative mortality.

Show MeSH
Related in: MedlinePlus