Assessment of the value of comorbidity indices for risk adjustment in colorectal surgery patients Journal Article


Authors: Strombom, P.; Widmar, M.; Keskin, M.; Gennarelli, R. L.; Lynn, P.; Smith, J. J.; Guillem, J. G.; Paty, P. B.; Nash, G. M.; Weiser, M. R.; Garcia-Aguilar, J.
Article Title: Assessment of the value of comorbidity indices for risk adjustment in colorectal surgery patients
Abstract: Background and Purpose: Comorbidity indices (CIs) are widely used in retrospective studies. We investigated the value of commonly used CIs in risk adjustment for postoperative complications after colorectal surgery. Methods: Patients undergoing colectomy without stoma for colonic neoplasia at a single institution from 2009 to 2014 were included. Four CIs were calculated or obtained for each patient, using administrative data: Charlson–Deyo (CCI-D), Charlson–Romano (CCI-R), Elixhauser Comorbidity Score, and American Society of Anesthesiologists classification. Outcomes of interest in the 90-day postoperative period were any surgical complication, surgical site infection (SSI), Clavien–Dindo (CD) grade 3 or higher complication, anastomotic leak or abscess, and nonroutine discharge. Base models were created for each outcome based on significant bivariate associations. Logistic regression models were constructed for each outcome using base models alone, and each index as an additional covariate. Models were also compared using the DeLong and Clarke–Pearson method for receiver operating characteristic (ROC) curves, with the CCI-D as the reference. Results: Overall, 1813 patients were included. Postoperative complications were reported in 756 (42%) patients. Only 9% of patients had a CD grade 3 or higher complication, and 22.8% of patients developed an SSI. Multivariable modeling showed equivalent performance of the base model and the base model augmented by the CIs for all outcomes. The ROC curves for the four indices were also similar. Conclusions: The inclusion of CIs added little to the base models, and all CIs performed similarly well. Our study suggests that CIs do not adequately risk-adjust for complications after colorectal surgery. © 2019, Society of Surgical Oncology.
Journal Title: Annals of Surgical Oncology
Volume: 26
Issue: 9
ISSN: 1068-9265
Publisher: Springer  
Date Published: 2019-09-01
Start Page: 2797
End Page: 2804
Language: English
DOI: 10.1245/s10434-019-07502-9
PUBMED: 31209671
PROVIDER: scopus
PMCID: PMC6684474
DOI/URL:
Notes: Article -- Export Date: 30 August 2019 -- Source: Scopus
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MSK Authors
  1. Philip B Paty
    383 Paty
  2. Jose Guillem
    382 Guillem
  3. Martin R Weiser
    355 Weiser
  4. Garrett Nash
    144 Nash
  5. Jesse Joshua Smith
    58 Smith
  6. Maria   Widmar
    10 Widmar
  7. Patricio Bernardo Lynn
    10 Lynn
  8. Metin   Keskin
    8 Keskin