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Age adjusted Charlson comorbidity index (a-CCI) AS a tool to predict 30-day post-operative outcome in general surgery
Hemanga Kumar Bhattacharjee1, M P Kaviyarasan1, Kh Jitenkumar Singh2
1Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India.
Insights
The age-adjusted Charlson Comorbidity Index (a-CCI) effectively predicts 30-day post-operative complications and mortality in general surgery. Higher a-CCI scores correlate with increased risks, highlighting its value in pre-operative assessment.
Area of Science:
- General Surgery
- Surgical Outcomes
- Comorbidity Assessment
Background:
- The age-adjusted Charlson Comorbidity Index (a-CCI) is established for long-term mortality prediction.
- Its utility in predicting short-term (30-day) post-operative outcomes in general surgery remains unclear.
Purpose of the Study:
- To evaluate the role of the a-CCI in predicting 30-day post-operative complications and mortality.
- To assess the clinical relevance of a-CCI in pre-operative evaluations for general surgery patients.
Main Methods:
- Prospective observational study of consecutive general surgery patients (January 2019 - December 2020).
- a-CCI calculated and stratified into Grade 0 (score=0), Grade A (score=1-2), and Grade B (score≥3).
- Post-operative complications graded using Clavien-Dindo (CD) system; analyzed using logistic regression.
Main Results:
- 31% of 925 patients experienced 30-day post-operative complications, including 2.7% mortality.
- Patients with Grade A and B a-CCI scores showed significantly higher odds of complications (1.2x and 1.84x, respectively) compared to Grade 0.
- Mortality risk was substantially increased in Grade A (3x) and Grade B (17.86x) a-CCI groups.
Conclusions:
- The a-CCI demonstrates significant clinical relevance for predicting early post-operative outcomes in general surgery.
- Incorporating a-CCI into pre-operative assessments can aid in risk stratification and patient management.
Introduction:
Age adjusted Charlson comorbidity index (a-CCI) is an established scoring system to predict long-term mortality. However, its role in predicting 30-day post-operative outcome in general surgery patients is not well elucidated.
Methods:
This was a prospective observational study. Consecutive patients operated under general anaesthesia between January 2019 and December 2020 were enrolled. Their a-CCI was calculated and stratified as Grade 0 comorbidities (a-CCI score = 0), Grade A comorbidities (a-CCI score = 1 and 2) and Grade B comorbidities (a-CCI score ≥ 3). Post-operative complications were graded according to Clavien Dindo (CD) grading system and classified as minor complications (CD Grades I and II), major complications (CD Grades III-IV) and mortality (CD Grade V). Binary logistic regression and multi-nominal logistic regression analysis were done and relative risk ratios were calculated.
Result:
A total of 925 patients were enrolled. The mean age was 42.75 (14-85 ± 10) years. 31% of our patients had complications within 30 days of surgery which included mortality in 2.7%. Compared with patients with Grade 0 comorbidities, the odds of getting complications is 1.2 times more in patients with Grade A comorbidities and 1.84 times more in patients with Grade B comorbidities (P = 0.205, 0.001 respectively). In comparison to patients with Grade 0 co-morbidities, risk of mortality is 3 and 17.86 times more in patients with Grade A and Grade B comorbidities (P = 0.121 and < 0.001 respectively).
Conclusion:
a-CCI has clinical relevance in general surgical patients and can predict early post-operative outcome. It should be a part of our armamentarium for pre-operative assessment of surgical patients.
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