Charlson Comorbidity Index as Predictor of Poor Surgical Outcomes in Patients Undergoing Minimally Invasive Hysterectomy by Gynecologic Oncologists

2020 ◽  
Vol 156 (3) ◽  
pp. e1-e2
Author(s):  
S. Grimes ◽  
A. McQuary ◽  
T. Castellano ◽  
K. Ding ◽  
K. Moxley
Keyword(s):  
Minimally Invasive ◽  
Surgical Outcomes ◽  
Charlson Comorbidity Index ◽  
Comorbidity Index ◽  
Minimally Invasive Hysterectomy

Evaluation of the Charlson comorbidity index to predict outcome after esophagectomy in older patients.

2011 ◽  
Vol 29 (4_suppl) ◽  
pp. 27-27
Author(s):  
A. Kothari ◽  
T. Bretl ◽  
T. Weigel
Keyword(s):  
Surgical Outcomes ◽  
Charlson Comorbidity Index ◽  
Length Of Hospital Stay ◽  
Elderly Age ◽  
Co Morbidity ◽  
Risk Patients ◽  
Comorbidity Index ◽  
Morbidity Index ◽  
Index Future ◽  
Morbid Conditions

27 Background: Esophagectomy remains a preferred treatment for several neoplastic and non-neoplastic conditions; however it is often avoided in elderly patients with several co-morbid conditions. Several centers endorse the use of the Charlson comorbidity index to predict surgical outcomes in high risk patients. To date, this standard measure of co-morbidity has not been used to predict surgical outcomes following esophagectomy in elderly (age ≥70) patients. Methods: We reviewed data from an IRB-approved, prospectively maintained thoracic surgery database over a three-year period (March, 2006 – March, 2009). We compared incidence of post-operative events, total length of stay, 30-day mortality, rate of readmission, and calculated Charlson comorbidity indices (CCI) for all patients. A validated electronic application was used to calculate CCI based on patient age, BMI, substance use, malignancy, and co-morbid diseases (CV, respiratory, GI, endocrine, inflammatory, psychiatric, neurologic, and immunologic). Results: There were 75 patients below the age of 70 and 41 patients ≥ 70 years old who underwent esophagectomy over the 3-year period studied. Patients over the age of 70 had a significantly higher CCI (5.02) than patients under the age of 70 (3.19, p < 0.05). However, the 30 day mortality in patients ≥ 70 (0.0%) and under 70 (2.3%) was not significantly different between groups (p = 0.33). There was no difference in median length of hospital stay (7 days vs. 7 days, p = 0.95) and rate of readmission (7.5% vs. 9.3%, p = 0.74) when comparing patients ≥ 70 and < 70 years old, respectively. Patients ≥ 70 had a significantly lower incidence of complications than patients under the age of 70 (34.1% vs. 60.0%, p < 0.05). Conclusions: Patients ≥ 70 years old had higher Charlson comorbidity indices than patients < 70 years old, however surgical outcomes in both groups following esophagectomy were similar. In this population, CCI may not be a valid tool for measuring surgical risk perhaps due to the inclusion of age in the index. Future study will focus on the development of a co-morbidity index which can predict outcomes following esophagectomy and is not biased by age. No significant financial relationships to disclose.

Factors Associated With Unplanned Admission in Patients Intended for Same Day Discharge After Minimally Invasive Hysterectomy for Endometrial Cancer

2021 ◽  
pp. 155335062110418
Author(s):  
Ji Son ◽  
Thang Tran ◽  
Meng Yao ◽  
Chad M. Michener
Keyword(s):  
Endometrial Cancer ◽  
Minimally Invasive ◽  
Operative Time ◽  
Gynecologic Oncology ◽  
Multivariable Analysis ◽  
Unplanned Admission ◽  
Pain Scores ◽  
Same Day Discharge ◽  
Comorbidity Index ◽  
Minimally Invasive Hysterectomy

Objectives. To identify factors that lead to successful same-day discharge compared with unplanned and planned admission after minimally invasive hysterectomy for endometrial cancer. Methods. Patients undergoing laparoscopic or robotic hysterectomy for endometrial cancer between 2016 and 2019 were retrospectively reviewed. 3 groups were created: same-day discarge (SDD), unplanned admission (UA), and planned admission(PA). Demographic/perioperative factors and encounters after discharge were compared. A multivariable logistic regression was performed. Results. 262 patients were included. By year, the success of SDD increased from 59.1% to 82.5%. Patients who underwent SDD compared with admission were younger (62.2 vs 66.2, P = .003) and had a lower Charlson Comorbidity Index (4 vs 5, P < .001). BMI was not significant. Comparing SDD and UA, shorter operative time (100.3 min vs 130.6 min, P = .037) was associated with SDD. Postoperative pain scores were not significant (3.8 vs 4.7, P = .086). The rate of unscheduled encounters within 30 days of discharge was not significantly different. On multivariable analysis, the odds of SDD decreased by 4% with each 1-year increase in age (OR .96, P = .017). Each 1-minute increase in operative time decreased the odds of SDD by 2% (OR .98, P < .001). Intraoperative acetaminophen (OR 2.78, P = .003) and ketorolac (OR 2.27, P = .031) were predictive of SDD. Conclusion. SDD can be safely incorporated into clinical practice in gynecologic oncology patients undergoing minimally invasive hysterectomy, even for patients older than previously reported. Shorter operative time was associated with SDD. The role of perioperative acetaminophen and ketorolac should be further investigated.

Predicting outcomes after minimally invasive esophagectomy with the Charlson comorbidity index

2012 ◽  
Vol 215 (3) ◽  
pp. S39-S40
Author(s):  
Ryan A. Macke ◽  
James D. Luketich ◽  
Ryan M. Levy ◽  
Dan Winger ◽  
Manisha Shende ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Charlson Comorbidity Index ◽  
Minimally Invasive Esophagectomy ◽  
Invasive Esophagectomy ◽  
Comorbidity Index

scholarly journals Charlson Comorbidity Index: An Inaccurate Predictor of Minimally Invasive Lumbar Spinal Fusion Outcomes

10.14444/8099 ◽  
2021 ◽  
pp. 8099
Author(s):  
Nathaniel W. Jenkins ◽  
James M. Parrish ◽  
Michael T. Nolte ◽  
Caroline N. Jadczak ◽  
Cara E. Geoghegan ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Spinal Fusion ◽  
Charlson Comorbidity Index ◽  
Lumbar Spinal Fusion ◽  
Comorbidity Index ◽  
Lumbar Spinal

Minimally invasive hysterectomy for endometriosis: Surgical outcomes based on surgeon specialty

2021 ◽  
pp. 228402652199020
Author(s):  
Olga Mutter ◽  
Sarah A Ackroyd ◽  
George A Taylor ◽  
Juan Diaz
Keyword(s):  
Minimally Invasive ◽  
Surgical Outcomes ◽  
Gynecologic Oncology ◽  
Primary Diagnosis ◽  
Unplanned Readmission ◽  
Improvement Program ◽  
Confounding Variables ◽  
American College Of Surgeons ◽  
Baseline Characteristics ◽  
Minimally Invasive Hysterectomy

Introduction: To evaluate differences in surgical outcomes of minimally invasive hysterectomy performed for endometriosis between general gynecologists and gynecologic oncologists. Methods: Utilizing the 2016–2018 American College of Surgeons National Surgical Quality Improvement Program (NSQIP) hysterectomy dataset, we evaluated baseline characteristics and surgical outcomes for patients who underwent a minimally invasive hysterectomy for endometriosis between general gynecology and gynecologic oncology groups. Results: From 2016 to 2018, a total of 3751 minimally invasive hysterectomies were performed for the primary diagnosis of endometriosis. Of these cases, 3129 (83.4%) were performed by general gynecologists and 622 (16.6%) by gynecologic oncologists. There were several differences in baseline characteristics between the groups. Notably, general gynecologists performed a higher proportion of vaginal hysterectomies (7.9% vs 0.6%, p < 0.01). There were no statistically significant differences in overall 30-day complications or mortality between general gynecology and oncology groups, with the exception of a higher rate of postoperative sepsis (0.8% vs 0.2%, p = 0.01) in hysterectomies performed by oncologists. Compared to general gynecologists, oncologists had a longer operative time (134.9 ± 65.4 min vs 129 ± 60.9 min, p = 0.05). Multivariate regression of multiple tracked and composite outcomes revealed no consistent confounding variables other than race. In fact, African American race was a statistically significant predictive factor of composite complications (OR 1.80, p < 0.01), morbidity (OR 1.84, p < 0.05), and unplanned readmission (OR 2.30, p < 0.01). Surgeon specialty was not associated with composite complications, hysterectomy-specific complications, or readmission. Conclusion: There are no significant differences in surgical outcomes for minimally invasive hysterectomy for endometriosis between these two surgical subspecialties.

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