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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

Receiver-operating characteristic (ROC) curves for the prediction of postoperative in-hospital mortality by different scores: the ASA Physical Status (AUROCASAPS 0.83), the original Charlson comorbidity index (CCI; AUROCCCI 0.87), the Charlson CCI recalibrated for surgical patients (sCCI; AUROCsCCI 0.90), and the surgical mortality score (SMS) composed of the sCCI and additional intraoperative variables (AUROCSMS 0.93). All ROC curves differ significantly in pairwise comparison (P < 0.001). ASA PS = American Society of Anesthesiologists Physical Status, AUROC = area under the receiver-operating characteristic curves.
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Figure 2: Receiver-operating characteristic (ROC) curves for the prediction of postoperative in-hospital mortality by different scores: the ASA Physical Status (AUROCASAPS 0.83), the original Charlson comorbidity index (CCI; AUROCCCI 0.87), the Charlson CCI recalibrated for surgical patients (sCCI; AUROCsCCI 0.90), and the surgical mortality score (SMS) composed of the sCCI and additional intraoperative variables (AUROCSMS 0.93). All ROC curves differ significantly in pairwise comparison (P < 0.001). ASA PS = American Society of Anesthesiologists Physical Status, AUROC = area under the receiver-operating characteristic curves.

Mentions: The quality of prediction of the CCI was superior to the ASA PS (AUROCCCI 0.865 [95% CI 0.859–0.871] vs AUROCASAPS 0.833 [95% CI 0.826–0.840]; P < 0.001; Figure 2). As shown in Table 3, the weights of the original CCI differed from the independent risk attributed to the CCI items. We therefore modified the CCI by adding up the regression coefficients of the respective comorbidities resulting in a calibrated sCCI. This modified sCCI showed a better predictability than the original CCI (AUROCsCCI 0.896 [95% CI 0.889–0.903] vs AUROCCCI 0.865 [95% CI 0.859–0.871]; P < 0.001; Figure 2).


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)

Receiver-operating characteristic (ROC) curves for the prediction of postoperative in-hospital mortality by different scores: the ASA Physical Status (AUROCASAPS 0.83), the original Charlson comorbidity index (CCI; AUROCCCI 0.87), the Charlson CCI recalibrated for surgical patients (sCCI; AUROCsCCI 0.90), and the surgical mortality score (SMS) composed of the sCCI and additional intraoperative variables (AUROCSMS 0.93). All ROC curves differ significantly in pairwise comparison (P < 0.001). ASA PS = American Society of Anesthesiologists Physical Status, AUROC = area under the receiver-operating characteristic curves.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 2: Receiver-operating characteristic (ROC) curves for the prediction of postoperative in-hospital mortality by different scores: the ASA Physical Status (AUROCASAPS 0.83), the original Charlson comorbidity index (CCI; AUROCCCI 0.87), the Charlson CCI recalibrated for surgical patients (sCCI; AUROCsCCI 0.90), and the surgical mortality score (SMS) composed of the sCCI and additional intraoperative variables (AUROCSMS 0.93). All ROC curves differ significantly in pairwise comparison (P < 0.001). ASA PS = American Society of Anesthesiologists Physical Status, AUROC = area under the receiver-operating characteristic curves.
Mentions: The quality of prediction of the CCI was superior to the ASA PS (AUROCCCI 0.865 [95% CI 0.859–0.871] vs AUROCASAPS 0.833 [95% CI 0.826–0.840]; P < 0.001; Figure 2). As shown in Table 3, the weights of the original CCI differed from the independent risk attributed to the CCI items. We therefore modified the CCI by adding up the regression coefficients of the respective comorbidities resulting in a calibrated sCCI. This modified sCCI showed a better predictability than the original CCI (AUROCsCCI 0.896 [95% CI 0.889–0.903] vs AUROCCCI 0.865 [95% CI 0.859–0.871]; P < 0.001; Figure 2).

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