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Using the age-adjusted Charlson comorbidity index to predict outcomes in emergency general surgery
Etienne St-Louis1, Sameena Iqbal, Liane S Feldman
1From the Division of General Surgery, Montreal General Hospital, Montreal, Quebec, Canada.
Insights
The Charlson Age-Comorbidity Index (CACI) effectively predicts 30-day mortality in emergency general surgery patients. This validated tool aids in assessing patient risk for improved surgical outcomes.
Area of Science:
- Surgical Outcomes Research
- Health Services Research
- Geriatric Medicine
Background:
- The Charlson Age-Comorbidity Index (CACI) is a weighted index assessing 1-year mortality risk.
- Its utility in predicting perioperative outcomes for emergency general surgery (EGS) patients was previously unevaluated.
Purpose of the Study:
- To evaluate the Charlson Age-Comorbidity Index (CACI) as a predictor of perioperative outcomes in an emergency general surgery population.
- To assess the CACI's accuracy in predicting 30-day mortality and intensive care unit (ICU) admission.
Main Methods:
- Retrospective chart review of 529 emergency general surgery admissions in 2010.
- Analysis of 257 patients who underwent surgery, recording CACI scores, 30-day mortality, and ICU admissions.
- Multivariate logistic regression and receiver operating characteristic (ROC) analyses were performed.
Main Results:
- CACI scores ranged from 0 to 16, with 11 deaths (4.3%) and 30 ICU admissions (11.7%).
- CACI significantly predicted 30-day mortality (adjusted odds ratio, 1.39; p = 0.0034) with high accuracy (Area Under Curve, 0.90).
- CACI also predicted ICU admission (adjusted odds ratio, 1.17; p < 0.0382), though less accurately than mortality.
Conclusions:
- The Charlson Age-Comorbidity Index (CACI) is a validated tool for predicting 30-day mortality in emergency general surgery.
- CACI demonstrates high accuracy for mortality prediction, comparable to multivariate models.
- While CACI predicts ICU admission, its predictive power is less than that of a comprehensive multivariate model.
Background:
We evaluated the role of the Charlson age-comorbidity index (CACI), a weighted comorbidity index that reflects cumulative increased likelihood of 1-year mortality, in predicting perioperative outcomes in an emergency general surgery population at a large Canadian teaching hospital.
Methods:
A retrospective chart review of emergency general surgery admissions in 2010 was conducted. Patients who had surgery were identified. Mode of surgery and CACI were recorded, as well as measures of outcome, including 30-day mortality and intensive care unit (ICU) admission. A multivariate stepwise logistic regression model was created to assess the effect of age-adjusted Charlson comorbidity index on postoperative outcomes while controlling for the effect of possible confounders. The prediction ability of CACI for mortality was assessed using receiver operating characteristic analyses considering the area under the curve and its 95% confidence intervals (CIs).
Results:
Of the 529 admissions to general surgery from the emergency department, 257 patients underwent a surgical intervention. The CACI scores ranged from 0 to 16. We described a total of 11 deaths (4.3%) and 30 ICU admissions (11.7%). CACI was associated with an increased risk of 30-day mortality (adjusted odds ratio,1.39; 95% CI, 1.11-1.73; p = 0.0034). Receiver operating characteristic analysis was consistent with high accuracy of CACI for mortality prediction alone, resulting in area under the curve or c statistic of 0.90 (95% CI, 0.84-0.95). CACI was similar in predicting mortality to a multivariate model. CACI was also found to be associated with ICU admission (adjusted odds ratio, 1.17; 95% CI, 1.01-1.37; p < 0.0382). CACI is not as good a predictor for ICU admission when compared with the multivariate model.
Conclusion:
We have shown that the CACI is a valid tool for 30-day mortality prediction in the context of emergency general surgery.
Level Of Evidence:
Prognostic study, level III.
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