Limits...
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.

Show MeSH

Related in: MedlinePlus

Receiver-operating characteristic (ROC) curves for prediction of postoperative in-hospital mortality in (A) patients never admitted to the intensive care unit (ICU) and (B) patients admitted to the ICU during their hospital stay by the American Society of Anesthesiologists Physical Status (ASA PS), the Charlson comorbidity index (CCI), the Charlson CCI for surgical patients (sCCI), and the surgical mortality score (SMS).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4554144&req=5

Figure 4: Receiver-operating characteristic (ROC) curves for prediction of postoperative in-hospital mortality in (A) patients never admitted to the intensive care unit (ICU) and (B) patients admitted to the ICU during their hospital stay by the American Society of Anesthesiologists Physical Status (ASA PS), the Charlson comorbidity index (CCI), the Charlson CCI for surgical patients (sCCI), and the surgical mortality score (SMS).

Mentions: Approximately one-third of all included patients were admitted to the ICU after surgery (35%; 47,386 of 182,886). Patients who had never been admitted to the ICU and presented an elevated risk of in-hospital death were detected especially well by the SMS (AUROCneverICU 0.90 [95% CI 0.77–0.88 vs 0.93] vs AUROCICU 0.84 [95% CI 0.83–0.85]; P < 0.001; Figure 4). Patients never admitted to the ICU were younger, had a lower ASA PS, had more often elective surgery, had less often intracranial, intrathoracic, or intraabdominal surgery, less comorbidities, a shorter hospital stay, and died less often (0.1% vs 4.4%; P < 0.001 for all variables; see Table 5, Supplemental Content, http://links.lww.com/MD/A215, which describes the study population divided by ICU admission). Admission to ICU remained independently associated with a higher SMS in multivariate analysis (see Table 6, Supplemental Content, http://links.lww.com/MD/A215, which shows the results of a linear regression model for the new SMS including ICU admission as independent variable).


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 prediction of postoperative in-hospital mortality in (A) patients never admitted to the intensive care unit (ICU) and (B) patients admitted to the ICU during their hospital stay by the American Society of Anesthesiologists Physical Status (ASA PS), the Charlson comorbidity index (CCI), the Charlson CCI for surgical patients (sCCI), and the surgical mortality score (SMS).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 4: Receiver-operating characteristic (ROC) curves for prediction of postoperative in-hospital mortality in (A) patients never admitted to the intensive care unit (ICU) and (B) patients admitted to the ICU during their hospital stay by the American Society of Anesthesiologists Physical Status (ASA PS), the Charlson comorbidity index (CCI), the Charlson CCI for surgical patients (sCCI), and the surgical mortality score (SMS).
Mentions: Approximately one-third of all included patients were admitted to the ICU after surgery (35%; 47,386 of 182,886). Patients who had never been admitted to the ICU and presented an elevated risk of in-hospital death were detected especially well by the SMS (AUROCneverICU 0.90 [95% CI 0.77–0.88 vs 0.93] vs AUROCICU 0.84 [95% CI 0.83–0.85]; P < 0.001; Figure 4). Patients never admitted to the ICU were younger, had a lower ASA PS, had more often elective surgery, had less often intracranial, intrathoracic, or intraabdominal surgery, less comorbidities, a shorter hospital stay, and died less often (0.1% vs 4.4%; P < 0.001 for all variables; see Table 5, Supplemental Content, http://links.lww.com/MD/A215, which describes the study population divided by ICU admission). Admission to ICU remained independently associated with a higher SMS in multivariate analysis (see Table 6, Supplemental Content, http://links.lww.com/MD/A215, which shows the results of a linear regression model for the new SMS including ICU admission as independent variable).

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