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Short-Form Charlson Comorbidity Index for Assessment of Perioperative Mortality After Radical Cystectomy
Paolo Dell'Oglio1,2,3, Zhe Tian1,4, Sami-Ramzi Leyh-Bannurah1,5
1Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada
Insights
A new short-form Deyo adaptation of the Charlson comorbidity index (DaCCI-SF) accurately predicts 90-day mortality after bladder cancer radical cystectomy. This tool uses fewer comorbidities than the original DaCCI, improving prediction for contemporary patients.
Area of Science:
- Urology
- Oncology
- Medical Informatics
Background:
- The Deyo adaptation of the Charlson comorbidity index (DaCCI) is widely used but not specific for bladder cancer (BCa) patients undergoing radical cystectomy (RC).
- Predicting 90-day mortality after RC is crucial for patient management and resource allocation.
Purpose of the Study:
- To develop and validate a short-form DaCCI (DaCCI-SF) specifically for predicting 90-day mortality in BCa patients treated with RC.
- To assess if DaCCI-SF offers improved accuracy compared to the original DaCCI.
Main Methods:
- Utilized the SEER-Medicare database (2000-2009) with 7,076 patients diagnosed with nonmetastatic BCa treated with RC.
- Developed logistic regression models using a development cohort (n=6,076) to identify key comorbidities for DaCCI-SF.
- Validated DaCCI and DaCCI-SF accuracy in an independent validation cohort (n=1,000).
Main Results:
- The optimal DaCCI-SF included 3 of the original 17 comorbidity groupings: congestive heart failure, cerebrovascular disease, and chronic pulmonary disease.
- DaCCI-SF demonstrated higher predictive accuracy (69.7%) compared to DaCCI (68.4%) in the validation cohort.
- Improved accuracy of DaCCI-SF was consistent across various subgroups, including age, stage, diversion type, and treatment period.
Conclusions:
- DaCCI-SF, utilizing only 17.6% of original comorbidity groupings, provides a more accurate prediction of 90-day post-RC mortality.
- This specialized tool offers enhanced prognostic capability for bladder cancer patients undergoing radical cystectomy, particularly in contemporary practice.
Abstract:
Background: The Deyo adaptation of the Charlson comorbidity index (DaCCI), which relies on 17 comorbid condition groupings, represents one of the most frequently used baseline comorbidity assessment tools in retrospective database studies. However, this index is not specific for patients with bladder cancer (BCa) treated with radical cystectomy (RC). The goal of this study was to develop a short-form of the original DaCCI (DaCCI-SF) that may specifically predict 90-day mortality after RC, with equal or better accuracy. Patients and Methods: Between 2000 and 2009, we identified 7,076 patients in the SEER-Medicare database with stage T1 through T4 nonmetastatic BCa treated with RC. We randomly divided the population into development (n=6,076) and validation (n=1,000) cohorts. Within the development cohort, logistic regression models tested the ability to predict 90-day mortality with various iterations of the DaCCI-SF, wherein <17 original comorbid condition groupings were included after adjusting for age, sex, race, T stage, and N stage. We relied on the Akaike information criterion to identify the most parsimonious and informative set of comorbid condition groupings. Accuracy of the DaCCI and the DaCCI-SF was tested in the external validation cohort. Results: Within the development cohort, the most parsimonious and informative model resulted in the inclusion of 3 of the 17 (17.6%) original comorbid condition groupings: congestive heart failure, cerebrovascular disease, and chronic pulmonary disease. Within the validation cohort, the accuracy was 68.4% for the DaCCI versus 69.7% for the DaCCI-SF. Higher accuracy of the DaCCI-SF was confirmed in subgroup analyses performed according to age (≤75 vs >75 years), stage (organ-confined vs non-organ-confined), type of diversion (ileal-conduit vs non-ileal-conduit), and treatment period. Conclusions: DaCCI-SF relies on 17.6% of the original comorbid condition groupings and provides higher accuracy for predicting 90-day mortality after RC compared with the original DaCCI, especially in most contemporary patients.
