Journal Article

Comparison of comorbidity indices for prediction of morbidity and mortality after major surgical procedures

Haeuser, Lorine, Noldus, Joachim, Ayub, Asha, Trinh, Quoc-Dien, Herzog, Peter, Cone, Eugene B., Nguyen, David-Dan, Mossanen, Matthew

2021

Overview

Assessing perioperative risk is essential for surgical decision-making. Our study compares the accuracy of comorbidity indices to predict morbidity and mortality. Analyzing the National Surgical Quality Improvement Program, 16 major procedures were identified and American Society of Anesthesiologists (ASA), Charlson Comorbidity Index and modified Frailty Index were calculated. We fit models with each comorbidity index for prediction of morbidity, mortality, and prolonged length of stay (pLOS). Decision Curve Analysis determined the effectiveness of each model. Of 650,437 patients, 11.7%, 6.0%, 17.0% and 0.75% experienced any, major complication, pLOS, and mortality, respectively. Each index was an independent predictor of morbidity, mortality, and pLOS (p < 0.05). While the indices performed similarly for morbidity and pLOS, ASA demonstrated greater net benefit for threshold probabilities of 1–5% for mortality. Models including readily available factors (age, sex) already provide a robust estimation of perioperative morbidity and mortality, even without considering comorbidity indices. All comorbidity indices show similar accuracy for prediction of morbidity and pLOS, while ASA, the score easiest to calculate, performs best in prediction of mortality. •Using comorbidity indices for prediction of perioperative morbidity and mortality.•ASA score, frailty index and CCI perform similarly for prediction of morbidity.•ASA score, the easiest to calculate, performs better for prediction of mortality.•Decision curve analysis determines the effectiveness of prediction models.

• Publisher: Elsevier Inc,Elsevier Limited
• Subject: Age / Aged / Aging / Aortic aneurysms / ASA score / Bone surgery / Charlson comorbidity index / Chronic obstructive pulmonary disease / Comorbidity / Comorbidity risk indices / Coronary vessels / Decision analysis / Decision curve analysis / Decision making / Decision theory / Diabetes / Female / Frailty / Frailty - epidemiology / Frailty index / Gastrointestinal surgery / Heart attacks / Heart surgery / Humans / Hysterectomy / Joint surgery / Length of Stay / Male / Middle Aged / Morbidity / Mortality / Orthopedics / Patients / Perioperative Period - mortality / Pneumonectomy / Pneumonia / Postoperative Complications - epidemiology / Postoperative Complications - etiology / Predictions / Quality control / Reproducibility of Results / Retrospective Studies / Risk Assessment - methods / Surgical Procedures, Operative - adverse effects / Surgical Procedures, Operative - mortality / Variables