Impact of comorbidity on outcome among acute non-traumatic surgical patients. Evaluation of Charlson comorbidity index.

OBJECTIVE

To determine the prevalence of comorbid conditions among acute non-traumatic general surgery patients. To assess the impact of comorbidity on outcomes and evaluate the effectiveness of using Charlson comorbidity index (CCI) in these patients.

METHODS

All acute non-traumatic general surgery patients admitted to King Saud Medical Complex, Riyadh, Saudi Arabia, between January 1, 2007 and December 31, 2007 were included (n=1296). Patient data were explored to record comorbidity, and the CCI score calculated. The length of hospital stay, post-operative complications and mortality were recorded as outcome measures. The outcomes in patients with comorbid conditions were compared with patients without comorbid conditions.

RESULTS

We found one or more comorbid conditions in 31.9% (n=414) patients. The CCI score ranged from 1-8. All 3 outcome measures were recorded significantly higher in patients with comorbidity compared to patients with no comorbid condition; length of stay, 17.3 versus 10.6 days (p<0.0001), post-operative complications 46.3% versus 31% (p<0.0001), mortality 7.7% versus 4.4% (p<0.0001). Severe comorbidity as indicated by higher CCI score significantly correlated with length of stay, r=0.30 (p<0.0001) and mortality, r=0.2645 (p<0.0001). Overall risk of mortality was 1.81 times higher with comorbidity (odds ratio 1.81, 95% confidence interval 1.087-3.012, p=0.0182).

CONCLUSION

Comorbidity caused increased hospital stay, post-operative complications, and mortality among acute non-traumatic general surgery patients. The CCI is a reliable comorbidity index, which can help in managing risks in surgical patients.