Department of Community and Family Medicine, Duke University Medical Center, Durham, P.O. Box 104006, NC 27710, USA.
Obes Surg. 2013 May;23(5):638-49. doi: 10.1007/s11695-012-0853-3.
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.
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).
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.
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.
接受腹腔镜 Roux-en-Y 胃旁路术（LRYGB）的患者通常存在大量合并症，这些合并症必须考虑在内，以适当评估预期的术后结果。Charlson/Deyo 和 Elixhauser 指数是广泛使用的合并症测量指标，这两个指数都有基于增强 ICD-9-CM 编码的修订算法。目前尚不清楚现有的合并症测量指标中哪一个最能预测 LRYGB 术后早期的结果。
使用全国住院患者样本，确定 2001 年至 2008 年间接受肥胖症 LRYGB 的年龄在 18 岁或以上的患者。根据原始和增强的 Charlson/Deyo 和 Elixhauser 指数评估合并症。使用多元逻辑回归，评估以下早期术后结果：总体术后并发症、住院时间和转为开放手术。使用 C 统计量和赤池信息量准则（AIC）评估四种合并症指数的模型性能并进行比较。
共纳入 70287 例患者。平均年龄为 43.1 岁（标准差，10.8），81.6%为女性，60.3%为白人。原始和增强的 Elixhauser 指数在预测手术结果方面均略优于 Charlson/Deyo 指数。所有四个模型的 C 统计量相似，但原始 Elixhauser 指数与所有手术结果的 AIC 最小。
在接受 LRYGB 的患者队列中，原始的 Elixhauser 指数是预测术后早期结果的最佳指标。然而，Charlson/Deyo 和 Elixhauser 指数之间的差异较小，这两个指数都为预测这一高风险患者人群的术后早期结果提供了有临床意义的见解。
