Dataset Information

Development of comorbidity score for patients undergoing major surgery.

ABSTRACT: Objective:To develop and validate a claims-based comorbidity score for patients undergoing major surgery, and compare its performance with established comorbidity scores.

Data source:Five percent Medicare data from 2007 to 2014.

Study design:Retrospective cohort study of patients aged ?65 years undergoing six major operations (N = 99 250).

Data collection:One-year mortality was the primary outcome. Secondary outcomes were hospital mortality, 30-day mortality, 30-day readmission, and length of stay. The comorbidity score was developed in the derivation cohort (70 percent sample) using logistic regression model. The comorbidity score was calibrated and validated in the validation cohort (30 percent sample), and compared against the Charlson, Elixhauser, and Centers for Medicare and Medicaid Services Hierarchical Condition Categories (CMS-HCC) comorbidity scores using c-statistic, net reclassification improvement, and integrated discrimination improvement.

Principal findings:In the validation cohort, the surgery-specific comorbidity score was well calibrated and performed better than the Charlson, Elixhauser, and CMS-HCC comorbidity scores for all outcomes; the performance was comparable to the CMS-HCC for 30-day readmission. For example, the surgery-specific comorbidity score (c-statistic = 0.792; 95% CI, 0.785-0.799) had greater discrimination than the Charlson (c-statistic = 0.747; 95% CI, 0.739-0.755), Elixhauser (c-statistic = 0.747; 95% CI, 0.735-0.755), or CMS-HCC (c-statistic = 0.755; 95% CI, 0.747-0.763) scores in predicting 1-year mortality. The net reclassification improvement and integrated discrimination improvement were greater for surgery-specific comorbidity score compared to the Charlson, Elixhauser, and CMS-HCC scores.

Conclusions:Compared to commonly used comorbidity measures, a surgery-specific comorbidity score better predicted outcomes in the surgical population.

SUBMITTER: Mehta HB

PROVIDER: S-EPMC6863229 | biostudies-literature | 2019 Dec

REPOSITORIES: biostudies-literature

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Development of comorbidity score for patients undergoing major surgery.

Mehta Hemalkumar B HB Yong Shan S Sura Sneha D SD Hughes Byron D BD Kuo Yong-Fang YF Williams Stephen B SB Tyler Douglas S DS Riall Taylor S TS Goodwin James S JS

Health services research 20191001 6

<h4>Objective</h4>To develop and validate a claims-based comorbidity score for patients undergoing major surgery, and compare its performance with established comorbidity scores.<h4>Data source</h4>Five percent Medicare data from 2007 to 2014.<h4>Study design</h4>Retrospective cohort study of patients aged ≥65 years undergoing six major operations (N = 99 250).<h4>Data collection</h4>One-year mortality was the primary outcome. Secondary outcomes were hospital mortality, 30-day mortality, 30-day ...[more]

PMID: 31576566

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Project description:BackgroundSarcopenia is a surrogate marker for malnutrition and frailty, which has been linked to higher complication rates and prolonged length of stay (LOS) after surgery. The study aim was to assess the correlation between computed tomography (CT)-based sarcopenia and short-term clinical outcomes after oncologic colon surgery.MethodsThis retrospective study included consecutive patients operated between May 2014 and December 2019. Three radiological indices of sarcopenia were measured at the level of the third lumbar vertebra on preoperative CT scans: skeletal muscle area (SMA), skeletal muscle index (SMI) (both markers of muscle quantity), and skeletal muscle radiation attenuation (SMRA) (marker of muscle quality). Patients with major complications (grade ≥ 3b according to the Clavien classification) were compared with those without. Statistical correlation between sarcopenia indices, LOS, and comprehensive complication index (CCI) was tested with the Pearson correlation coefficient.ResultsA total of 325 patients were included. Mean age was 67 years [standard deviation (SD) 14.3], mean body mass index was 26.0 kg/m2 (SD 5.3), and 193 (59%) were male. Fifty patients (15.4%) had major complications, while 275 (84.6%) did not. Patients with major complications had more open surgery (52 vs. 21%, P < 0.01), intraoperative blood loss (257 vs. 102 mL, P = 0.035), and intraoperative complications (22 vs. 9%, P = 0.012). Patients with major complications had significantly increased CCI scores (53 vs. 6, P < 0.01), reoperations (74 vs. 0%, P < 0.01), and LOS (33 vs. 7, P < 0.01). SMA and SMI were comparable between both groups (126.0 vs. 125.2 cm2 , P = 0.974, and 43.4 vs. 44.3 cm2 /m2 , P = 0.636, respectively), while SMRA was significantly lower in patients with major complications (33.6 vs. 37.3 HU, P = 0.018). A lower SMRA was correlated with prolonged LOS (r = -0.207, P < 0.01) and higher CCI (r = -0.144, P < 0.01), while the other sarcopenia indices had no influence on surgical outcomes.ConclusionsMuscle quality (SMRA) as a specific sarcopenia marker was lower in patients with major complications and seems to prevail over muscle quantity (SMA and SMI) in the prediction of adverse outcomes after oncologic colon surgery.

Dataset Information

Development of comorbidity score for patients undergoing major surgery.

Publications

Development of comorbidity score for patients undergoing major surgery.

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