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Utility of the Charlson Comorbidity Index in the Preoperative Evaluation of Patients Undergoing Cardiac Surgery

Daniel Manzur-Sandoval1, Monserrat Echeverria-Ortuño1, Rodrigo Gopar-Nieto2

  • 1Instituto Nacional de Cardiología Ignacio Chávez Cardiovascular Critical Care Unit Mexico City Mexico Cardiovascular Critical Care Unit, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico.

Brazilian Journal of Cardiovascular Surgery
|February 2, 2026
PubMed

Insights

The Charlson Comorbidity Index (CCI) effectively predicts postoperative complications in cardiac surgery patients. Higher CCI scores correlate with increased risks of delirium, stroke, and renal replacement therapy, aiding in perioperative planning.

Area of Science:

  • Cardiology
  • Surgical Outcomes Research
  • Comorbidity Assessment

Background:

  • The Charlson Comorbidity Index (CCI) is crucial for assessing patient comorbidities and predicting adverse outcomes in surgery.
  • In cardiac surgery, comorbidities significantly impact postoperative complication rates and mortality.
  • This study investigates the predictive value of the CCI for perioperative complications in cardiac surgery patients.

Purpose of the Study:

  • To evaluate the Charlson Comorbidity Index (CCI) as a predictor of postoperative complications in adult patients undergoing cardiac surgery.
  • To assess the association between preoperative comorbidity burden, quantified by CCI, and the incidence of adverse perioperative events.
  • To determine the utility of CCI in enhancing risk stratification and guiding clinical management for cardiac surgery patients.

Main Methods:

  • An observational, cross-sectional study retrospectively analyzed data from 483 adult patients who underwent cardiac surgery with cardiopulmonary bypass.
  • Patients were stratified into mild (CCI 0-1), moderate (CCI 2), and severe (CCI ≥ 3) comorbidity groups.
  • Statistical analyses, including chi-square, Mann-Whitney U, and logistic regression (adjusted for age and sex), were employed to assess the relationship between CCI and postoperative complications.

Main Results:

  • Patients with severe comorbidity (CCI ≥ 3) exhibited significantly higher rates of postoperative delirium (27.3% vs. 9.4%), stroke (P=0.03), transfusion needs (69.7% vs. 47.2%), and renal replacement therapy (18.2% vs. 5.3%).
  • Median Sequential Organ Failure Assessment (SOFA) scores at 24 hours post-surgery were notably higher in the severe comorbidity group (P=0.00).
  • Logistic regression identified delirium (OR: 3.13), nosocomial pneumonia (OR: 3.10), acute kidney injury (OR: 2.28), and renal replacement therapy (OR: 4.10) as independent predictors of severe comorbidity, even after adjusting for age, sex, and CABG.

Conclusions:

  • The Charlson Comorbidity Index (CCI) is a valuable and effective tool for predicting postoperative complications in patients undergoing cardiac surgery.
  • Early identification of patient comorbidities using the CCI is essential for comprehensive perioperative planning and optimizing clinical outcomes.
  • Integration of the CCI into routine clinical practice is recommended to improve patient management and risk stratification in cardiac surgery.
Abstract

Keywords:
Age FactorsCardiac Surgical ProceduresComorbiditiesCoronary Artery BypassPostoperative PeriodRisk Factors.

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