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The Application of Comorbidity Indices to Predict Early Postoperative Outcomes After Laparoscopic Roux-en-Y Gastric Bypass: A Nationwide Comparative Analysis of Over 70,000 Cases

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Abstract

Background

Patients undergoing laparoscopic Roux-en-Y gastric bypass (LRYGB) often have substantial comorbidities, which must be taken into account to appropriately assess expected postoperative outcomes. The Charlson/Deyo and Elixhauser indices are widely used comorbidity measures, both of which also have revised algorithms based on enhanced ICD-9-CM coding. It is currently unclear which of the existing comorbidity measures best predicts early postoperative outcomes following LRYGB.

Methods

Using the Nationwide Inpatient Sample, patients 18 years or older undergoing LRYGB for obesity between 2001 and 2008 were identified. Comorbidities were assessed according to the original and enhanced Charlson/Deyo and Elixhauser indices. Using multivariate logistic regression, the following early postoperative outcomes were assessed: overall postoperative complications, length of hospital stay, and conversion to open surgery. Model performance for the four comorbidity indices was assessed and compared using C-statistics and the Akaike’s information criterion (AIC).

Results

A total of 70,287 patients were included. Mean age was 43.1 years (SD, 10.8), 81.6 % were female and 60.3 % were White. Both the original and enhanced Elixhauser indices modestly outperformed the Charlson/Deyo in predicting the surgical outcomes. All four models had similar C-statistics, but the original Elixhauser index was associated with the smallest AIC for all of the surgical outcomes.

Conclusions

The original Elixhauser index is the best predictor of early postoperative outcomes in our cohort of patients undergoing LRYGB. However, differences between the Charlson/Deyo and Elixhauser indices are modest, and each of these indices provides clinically relevant insight for predicting early postoperative outcomes in this high-risk patient population.

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Conflicts of Interest

All contributing authors, including Jin Hee Shin, Mathias Worni, Anthony W. Castleberry, Ricardo Pietrobon, Philip A. Omotosho, Mina Silberberg, and Truls Østbye, declare that they have no conflicts of interest in relation to this manuscript.

Author information

Authors and Affiliations

  1. Department of Community and Family Medicine, Duke University Medical Center, Durham, NC, P.O. Box 104006, 27710, USA

    Jin Hee Shin, Mina Silberberg & Truls Østbye

  2. Research on Research Group, Department of Surgery, Duke University Medical Center, Durham, NC, USA

    Mathias Worni & Ricardo Pietrobon

  3. Department of Surgery, Duke University Medical Center, Durham, NC, USA

    Anthony W. Castleberry & Philip A. Omotosho

  4. Department of Visceral Surgery and Medicine, Inselspital, University of Berne, Berne, Switzerland

    Mathias Worni

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  1. Jin Hee Shin
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Correspondence to Truls Østbye.

Appendix

Appendix

 

ICD-9-CM code

Postoperative complications

Mechanical wound complications

 Postoperative hematoma

998.12

 Postoperative seroma (noninfected)

998.13

 Disruption of operative wound

998.3

 Disruption of wound unspecified

998.30

 Disruption of internal operation (surgical) wound

998.31

 Disruption of external operation (surgical) wound

998.32

 Persistent postoperative fistula

998.6

 Delayed wound healing

998.83

Infections

 Postoperative infection

998.5

 Postoperative infected seroma

998.51

 Postoperative skin abscess/infection

998.59

 Postoperative septic wound complications

998.59

 Postoperative intraabdominal/subdiaphragmatic abscess

998.59

Urinary/renal complications

 Postoperative urinary retention

997.5

 Postoperative urinary tract infection

997.5

 Acute renal failure

997.5

Pulmonary complications

 Postoperative acute pneumothorax

512.1

 Postoperative pulmonary edema

518.4

 Adult respiratory distress syndrome following surgery

518.5

 Transfusion-related acute lung injury

518.7

 Postoperative atelectasis/pneumonia

997.3

 Mendelson syndrome resulting from a procedure

997.3

Gastrointestinal complications

 Postoperative vomiting

564.3

 Diarrhea following gastrointestinal surgery

564.4

 Postoperative small bowel obstruction/ileus (requiring nasogastric tube)

997.4

 Complication of anastomosis of gastrointestinal tract

997.4

Cardiovascular complications

 Postoperative hypotension

458.29

 Postoperative stroke

997.02

 Cardiac arrest/insufficiency during or resulting from a procedure

997.1

 Phlebitis or thrombophlebitis from procedure

997.2

Systemic complications

 Postoperative shock

998.0

 Postoperative fever

998.89

 Unspecified complication of procedure, not elsewhere classified

998.9

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Shin, J.H., Worni, M., Castleberry, A.W. et al. The Application of Comorbidity Indices to Predict Early Postoperative Outcomes After Laparoscopic Roux-en-Y Gastric Bypass: A Nationwide Comparative Analysis of Over 70,000 Cases. OBES SURG 23, 638–649 (2013). https://doi.org/10.1007/s11695-012-0853-3

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