Comparison of comorbidity scores in predicting surgical outcomes

Hemalkumar Mehta, Francesca Dimou, Deepak Adhikari, Nina P. Tamirisa, Eric Sieloff, Taylor P. Williams, Yong Fang Kuo, Taylor S. Riall

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

Introduction: The optimal methodology for assessing comorbidity to predict various surgical outcomes such as mortality, readmissions, complications, and failure to rescue (FTR) using claims data has not been established. Objective: Compare diagnosis-based and prescription-based comorbidity scores for predicting surgical outcomes. Methods: We used 100% Texas Medicare data (2006-2011) and included patients undergoing coronary artery bypass grafting, pulmonary lobectomy, endovascular repair of abdominal aortic aneurysm, open repair of abdominal aortic aneurysm, colectomy, and hip replacement (N = 39,616). The ability of diagnosis-based [Charlson comorbidity score, Elixhauser comorbidity score, Combined Comorbidity Score, Centers for Medicare and Medicaid Services-Hierarchical Condition Categories (CMS-HCC)] versus prescription-based Chronic disease score in predicting 30-day mortality, 1-year mortality, 30-day readmission, complications, and FTR were compared using c-statistics (c) and integrated discrimination improvement (IDI). Results: The overall 30-day mortality was 5.8%, 1-year mortality was 17.7%, 30-day readmission was 14.1%, complication rate was 39.7%, and FTR was 14.5%. CMS-HCC performed the best in predicting surgical outcomes (30-d mortality, c = 0.797, IDI = 4.59%; 1-y mortality, c = 0.798, IDI = 9.60%; 30-d readmission, c = 0.630, IDI = 1.27%; complications, c = 0.766, IDI = 9.37%; FTR, c = 0.811, IDI = 5.24%) followed by Elixhauser comorbidity index/disease categories (30-d mortality, c = 0.750, IDI = 2.37%; 1-y mortality, c = 0.755, IDI = 5.82%; 30-d readmission, c = 0.629, IDI = 1.43%; complications, c = 0.730, IDI = 3.99%; FTR, c = 0.749, IDI = 2.17%). Addition of prescription-based scores to diagnosisbased scores did not improve performance. Conclusions: The CMS-HCC had superior performance in predicting surgical outcomes. Prescription-based scores, alone or in addition to diagnosis-based scores, were not better than any diagnosis-based scoring system.

Original languageEnglish (US)
Pages (from-to)180-187
Number of pages8
JournalMedical Care
Volume54
Issue number2
DOIs
StatePublished - 2016

Fingerprint

Comorbidity
Mortality
Dilatation and Curettage
Centers for Medicare and Medicaid Services (U.S.)
Prescriptions
Abdominal Aortic Aneurysm
Colectomy
Medicare
Coronary Artery Bypass
Hip
Chronic Disease
Lung

Keywords

  • Charlson comorbidity score
  • Chronic disease score
  • CMS-HCC
  • Elixhauser comorbidity score
  • Surgery
  • Surgical outcomes

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

Cite this

Mehta, H., Dimou, F., Adhikari, D., Tamirisa, N. P., Sieloff, E., Williams, T. P., ... Riall, T. S. (2016). Comparison of comorbidity scores in predicting surgical outcomes. Medical Care, 54(2), 180-187. https://doi.org/10.1097/MLR.0000000000000465

Comparison of comorbidity scores in predicting surgical outcomes. / Mehta, Hemalkumar; Dimou, Francesca; Adhikari, Deepak; Tamirisa, Nina P.; Sieloff, Eric; Williams, Taylor P.; Kuo, Yong Fang; Riall, Taylor S.

In: Medical Care, Vol. 54, No. 2, 2016, p. 180-187.

Research output: Contribution to journalArticle

Mehta, H, Dimou, F, Adhikari, D, Tamirisa, NP, Sieloff, E, Williams, TP, Kuo, YF & Riall, TS 2016, 'Comparison of comorbidity scores in predicting surgical outcomes', Medical Care, vol. 54, no. 2, pp. 180-187. https://doi.org/10.1097/MLR.0000000000000465
Mehta H, Dimou F, Adhikari D, Tamirisa NP, Sieloff E, Williams TP et al. Comparison of comorbidity scores in predicting surgical outcomes. Medical Care. 2016;54(2):180-187. https://doi.org/10.1097/MLR.0000000000000465
Mehta, Hemalkumar ; Dimou, Francesca ; Adhikari, Deepak ; Tamirisa, Nina P. ; Sieloff, Eric ; Williams, Taylor P. ; Kuo, Yong Fang ; Riall, Taylor S. / Comparison of comorbidity scores in predicting surgical outcomes. In: Medical Care. 2016 ; Vol. 54, No. 2. pp. 180-187.
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abstract = "Introduction: The optimal methodology for assessing comorbidity to predict various surgical outcomes such as mortality, readmissions, complications, and failure to rescue (FTR) using claims data has not been established. Objective: Compare diagnosis-based and prescription-based comorbidity scores for predicting surgical outcomes. Methods: We used 100{\%} Texas Medicare data (2006-2011) and included patients undergoing coronary artery bypass grafting, pulmonary lobectomy, endovascular repair of abdominal aortic aneurysm, open repair of abdominal aortic aneurysm, colectomy, and hip replacement (N = 39,616). The ability of diagnosis-based [Charlson comorbidity score, Elixhauser comorbidity score, Combined Comorbidity Score, Centers for Medicare and Medicaid Services-Hierarchical Condition Categories (CMS-HCC)] versus prescription-based Chronic disease score in predicting 30-day mortality, 1-year mortality, 30-day readmission, complications, and FTR were compared using c-statistics (c) and integrated discrimination improvement (IDI). Results: The overall 30-day mortality was 5.8{\%}, 1-year mortality was 17.7{\%}, 30-day readmission was 14.1{\%}, complication rate was 39.7{\%}, and FTR was 14.5{\%}. CMS-HCC performed the best in predicting surgical outcomes (30-d mortality, c = 0.797, IDI = 4.59{\%}; 1-y mortality, c = 0.798, IDI = 9.60{\%}; 30-d readmission, c = 0.630, IDI = 1.27{\%}; complications, c = 0.766, IDI = 9.37{\%}; FTR, c = 0.811, IDI = 5.24{\%}) followed by Elixhauser comorbidity index/disease categories (30-d mortality, c = 0.750, IDI = 2.37{\%}; 1-y mortality, c = 0.755, IDI = 5.82{\%}; 30-d readmission, c = 0.629, IDI = 1.43{\%}; complications, c = 0.730, IDI = 3.99{\%}; FTR, c = 0.749, IDI = 2.17{\%}). Addition of prescription-based scores to diagnosisbased scores did not improve performance. Conclusions: The CMS-HCC had superior performance in predicting surgical outcomes. Prescription-based scores, alone or in addition to diagnosis-based scores, were not better than any diagnosis-based scoring system.",
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AU - Mehta, Hemalkumar

AU - Dimou, Francesca

AU - Adhikari, Deepak

AU - Tamirisa, Nina P.

AU - Sieloff, Eric

AU - Williams, Taylor P.

AU - Kuo, Yong Fang

AU - Riall, Taylor S.

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N2 - Introduction: The optimal methodology for assessing comorbidity to predict various surgical outcomes such as mortality, readmissions, complications, and failure to rescue (FTR) using claims data has not been established. Objective: Compare diagnosis-based and prescription-based comorbidity scores for predicting surgical outcomes. Methods: We used 100% Texas Medicare data (2006-2011) and included patients undergoing coronary artery bypass grafting, pulmonary lobectomy, endovascular repair of abdominal aortic aneurysm, open repair of abdominal aortic aneurysm, colectomy, and hip replacement (N = 39,616). The ability of diagnosis-based [Charlson comorbidity score, Elixhauser comorbidity score, Combined Comorbidity Score, Centers for Medicare and Medicaid Services-Hierarchical Condition Categories (CMS-HCC)] versus prescription-based Chronic disease score in predicting 30-day mortality, 1-year mortality, 30-day readmission, complications, and FTR were compared using c-statistics (c) and integrated discrimination improvement (IDI). Results: The overall 30-day mortality was 5.8%, 1-year mortality was 17.7%, 30-day readmission was 14.1%, complication rate was 39.7%, and FTR was 14.5%. CMS-HCC performed the best in predicting surgical outcomes (30-d mortality, c = 0.797, IDI = 4.59%; 1-y mortality, c = 0.798, IDI = 9.60%; 30-d readmission, c = 0.630, IDI = 1.27%; complications, c = 0.766, IDI = 9.37%; FTR, c = 0.811, IDI = 5.24%) followed by Elixhauser comorbidity index/disease categories (30-d mortality, c = 0.750, IDI = 2.37%; 1-y mortality, c = 0.755, IDI = 5.82%; 30-d readmission, c = 0.629, IDI = 1.43%; complications, c = 0.730, IDI = 3.99%; FTR, c = 0.749, IDI = 2.17%). Addition of prescription-based scores to diagnosisbased scores did not improve performance. Conclusions: The CMS-HCC had superior performance in predicting surgical outcomes. Prescription-based scores, alone or in addition to diagnosis-based scores, were not better than any diagnosis-based scoring system.

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