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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.

Publication ,  Journal Article
Shin, JH; Worni, M; Castleberry, AW; Pietrobon, R; Omotosho, PA; Silberberg, M; Østbye, T
Published in: Obes Surg
May 2013

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.

Duke Scholars

Published In

Obes Surg

DOI

EISSN

1708-0428

Publication Date

May 2013

Volume

23

Issue

5

Start / End Page

638 / 649

Location

United States

Related Subject Headings

  • Weight Loss
  • United States
  • Treatment Outcome
  • Time Factors
  • Surgery
  • Prognosis
  • Postoperative Period
  • Obesity, Morbid
  • Middle Aged
  • Male
 

Citation

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ICMJE
MLA
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Shin, J. H., Worni, M., Castleberry, A. W., Pietrobon, R., Omotosho, P. A., Silberberg, M., & Østbye, T. (2013). 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(5), 638–649. https://doi.org/10.1007/s11695-012-0853-3
Shin, Jin Hee, Mathias Worni, Anthony W. Castleberry, Ricardo Pietrobon, Philip A. Omotosho, Mina Silberberg, and Truls Østbye. “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, no. 5 (May 2013): 638–49. https://doi.org/10.1007/s11695-012-0853-3.
Shin JH, Worni M, Castleberry AW, Pietrobon R, Omotosho PA, Silberberg M, Østbye T. 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. 2013 May;23(5):638–649.
Journal cover image

Published In

Obes Surg

DOI

EISSN

1708-0428

Publication Date

May 2013

Volume

23

Issue

5

Start / End Page

638 / 649

Location

United States

Related Subject Headings

  • Weight Loss
  • United States
  • Treatment Outcome
  • Time Factors
  • Surgery
  • Prognosis
  • Postoperative Period
  • Obesity, Morbid
  • Middle Aged
  • Male