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Ad J J C Bogers - One of the best experts on this subject based on the ideXlab platform.

  • Charlson Comorbidity Index as a predictor of long term outcome after surgery for nonsmall cell lung cancer
    European Journal of Cardio-Thoracic Surgery, 2005
    Co-Authors: Ozcan Birim, Pieter A Kappetein, Ad J J C Bogers
    Abstract:

    Objective: To evaluate the impact of the Charlson Comorbidity Index on long-term survival in nonsmall cell lung cancer surgery and determine whether this Index is a better predictor of long-term survival than individual comorbid conditions. Methods: From January 1989 to December 2001, 433 (340 men, 93 women) consecutive curative resections for nonsmall cell lung cancer were performed. Each patient was preoperatively assessed according to the Charlson Comorbidity Index. Survival curves were estimated by the Kaplan—Meier method. Risk factors for overall and disease free survival were determined by univariate and multivariate Cox regression analysis. Results: The patients ranged in age from 37 to 82 years, with a mean age of 65 years. Hospital mortality was 3.7%. Five-year overall and disease free survival was 45 and 43%, respectively. Among patients with Charlson Comorbidity grade 0, 5-year overall survival was 52%, among patients with Charlson Comorbidity grade 1—2 it was 48%, and among patients with Charlson Comorbidity grade � 3 it was 28%. Univariate analysis showed that male gender, age, congestive heart failure, chronic pulmonary disease, Charlson Comorbidity Index, clinical stage, pathological stage, and type of resection were significantly associated with an impaired survival. Multivariate analysis showed that age (relative risk, 1.02; 95% confidence interval, 1.01—1.03), Charlson Comorbidity grade 1—2 (relative risk, 1.4; 95% confidence interval, 1.0—1.8), Charlson Comorbidity grade � 3 (relative risk, 2.2; 95% confidence interval, 1.5— 3.1), bilobectomy (relative risk, 1.7; 95% confidence interval, 1.2—2.5), pneumonectomy (relative risk, 1.5; 95% confidence interval, 1.1—2.0), pathological stage IB (relative risk, 1.5; 95% confidence interval, 1.1—2.2), IIB (relative risk, 1.9; 95% confidence interval, 1.2—3.0), IIIA (relative risk, 1.9; 95% confidence interval, 1.1—3.1), IIIB (relative risk, 2.8; 95% confidence interval, 1.2—6.8), and IV (relative risk, 12.4; 95% confidence interval,3.2—48.2),wereassociatedwithan impairedsurvival.Conclusions:TheCharlsonComorbidity Indexis a betterpredictor of survivalthan individual comorbid conditions in nonsmall cell lung cancer surgery. We recommend the use of a validated Comorbidity Index in the selection of patients for NSCLC surgery. # 2005 Elsevier B.V. All rights reserved.

  • validation of the Charlson Comorbidity Index in patients with operated primary non small cell lung cancer
    European Journal of Cardio-Thoracic Surgery, 2003
    Co-Authors: Ozcan Birim, Alexander P W M Maat, Ariepieter Kappetein, J P Van Meerbeeck, R A M Damhuis, Ad J J C Bogers
    Abstract:

    Objective: To validate the influence of the Charlson Comorbidity Index (CCI) in patients with operated primary non-small cell lung cancer. Methods: From January 1996 to December 2001, 205 consecutive resections for non-small cell lung cancer were performed at the Erasmus Medical Center Rotterdam. The patients ranged in age from 29 to 82 years, with a mean age of 64 years. In a retrospective study, each patient was scaled according to the CCI and the complications of surgery were determined. Results: The hospital mortality was 2.4% (5/205). Of the 205 patients 167 (32.7%) experienced minor complications and 32 (15.6%) major complications. In univariate analysis, gender, grades 3–4 of the CCI, any prior tumor treated in the last 5 years and chronic pulmonary disease were significant predictors of adverse outcome. Multivariate analysis showed that only grades 3–4 of the CCI was predictive (odds ratio ¼ 9.8; 95% confidence interval ¼ 2.1–45.9). Although only Comorbidity grades 3–4 was a significant predictor, for every increase of the Comorbidity grade the relative risk of adverse outcome showed a slight increase. Conclusion: The CCI is strongly correlated with higher risk of surgery in primary non-small cell lung cancer patients and is a better predictor than individual risk factors. q 2002 Elsevier Science B.V. All rights reserved.

Jonathan N Grauer - One of the best experts on this subject based on the ideXlab platform.

Ozcan Birim - One of the best experts on this subject based on the ideXlab platform.

  • Charlson Comorbidity Index as a predictor of long term outcome after surgery for nonsmall cell lung cancer
    European Journal of Cardio-Thoracic Surgery, 2005
    Co-Authors: Ozcan Birim, Pieter A Kappetein, Ad J J C Bogers
    Abstract:

    Objective: To evaluate the impact of the Charlson Comorbidity Index on long-term survival in nonsmall cell lung cancer surgery and determine whether this Index is a better predictor of long-term survival than individual comorbid conditions. Methods: From January 1989 to December 2001, 433 (340 men, 93 women) consecutive curative resections for nonsmall cell lung cancer were performed. Each patient was preoperatively assessed according to the Charlson Comorbidity Index. Survival curves were estimated by the Kaplan—Meier method. Risk factors for overall and disease free survival were determined by univariate and multivariate Cox regression analysis. Results: The patients ranged in age from 37 to 82 years, with a mean age of 65 years. Hospital mortality was 3.7%. Five-year overall and disease free survival was 45 and 43%, respectively. Among patients with Charlson Comorbidity grade 0, 5-year overall survival was 52%, among patients with Charlson Comorbidity grade 1—2 it was 48%, and among patients with Charlson Comorbidity grade � 3 it was 28%. Univariate analysis showed that male gender, age, congestive heart failure, chronic pulmonary disease, Charlson Comorbidity Index, clinical stage, pathological stage, and type of resection were significantly associated with an impaired survival. Multivariate analysis showed that age (relative risk, 1.02; 95% confidence interval, 1.01—1.03), Charlson Comorbidity grade 1—2 (relative risk, 1.4; 95% confidence interval, 1.0—1.8), Charlson Comorbidity grade � 3 (relative risk, 2.2; 95% confidence interval, 1.5— 3.1), bilobectomy (relative risk, 1.7; 95% confidence interval, 1.2—2.5), pneumonectomy (relative risk, 1.5; 95% confidence interval, 1.1—2.0), pathological stage IB (relative risk, 1.5; 95% confidence interval, 1.1—2.2), IIB (relative risk, 1.9; 95% confidence interval, 1.2—3.0), IIIA (relative risk, 1.9; 95% confidence interval, 1.1—3.1), IIIB (relative risk, 2.8; 95% confidence interval, 1.2—6.8), and IV (relative risk, 12.4; 95% confidence interval,3.2—48.2),wereassociatedwithan impairedsurvival.Conclusions:TheCharlsonComorbidity Indexis a betterpredictor of survivalthan individual comorbid conditions in nonsmall cell lung cancer surgery. We recommend the use of a validated Comorbidity Index in the selection of patients for NSCLC surgery. # 2005 Elsevier B.V. All rights reserved.

  • validation of the Charlson Comorbidity Index in patients with operated primary non small cell lung cancer
    European Journal of Cardio-Thoracic Surgery, 2003
    Co-Authors: Ozcan Birim, Alexander P W M Maat, Ariepieter Kappetein, J P Van Meerbeeck, R A M Damhuis, Ad J J C Bogers
    Abstract:

    Objective: To validate the influence of the Charlson Comorbidity Index (CCI) in patients with operated primary non-small cell lung cancer. Methods: From January 1996 to December 2001, 205 consecutive resections for non-small cell lung cancer were performed at the Erasmus Medical Center Rotterdam. The patients ranged in age from 29 to 82 years, with a mean age of 64 years. In a retrospective study, each patient was scaled according to the CCI and the complications of surgery were determined. Results: The hospital mortality was 2.4% (5/205). Of the 205 patients 167 (32.7%) experienced minor complications and 32 (15.6%) major complications. In univariate analysis, gender, grades 3–4 of the CCI, any prior tumor treated in the last 5 years and chronic pulmonary disease were significant predictors of adverse outcome. Multivariate analysis showed that only grades 3–4 of the CCI was predictive (odds ratio ¼ 9.8; 95% confidence interval ¼ 2.1–45.9). Although only Comorbidity grades 3–4 was a significant predictor, for every increase of the Comorbidity grade the relative risk of adverse outcome showed a slight increase. Conclusion: The CCI is strongly correlated with higher risk of surgery in primary non-small cell lung cancer patients and is a better predictor than individual risk factors. q 2002 Elsevier Science B.V. All rights reserved.

Manish K Sethi - One of the best experts on this subject based on the ideXlab platform.

  • higher Charlson Comorbidity Index scores are associated with increased hospital length of stay after lower extremity orthopaedic trauma
    Journal of Orthopaedic Trauma, 2017
    Co-Authors: Nikita Lakomkin, William T Obremskey, Parth Kothari, Ashley C Dodd, Jacob P Vanhouten, Mahesh Yarlagadda, Cory A Collinge, Manish K Sethi
    Abstract:

    OBJECTIVES The purpose of this study was to explore the relationship between preoperative Charlson Comorbidity Index (CCI) and postoperative length of stay (LOS) for lower extremity and hip/pelvis orthopaedic trauma patients. DESIGN Retrospective. SETTING Urban level 1 trauma center. PATIENTS/PARTICIPANTS A total of 1561 patients treated for isolated lower extremity and pelvis fractures between 2000 and 2012. INTERVENTIONS Surgical intervention for fractures MAIN OUTCOME MEASUREMENTS:: The main outcome metric was LOS. Negative binomial regression analysis was used to examine the association between CCI and LOS while controlling for significant confounders. RESULTS One thousand five hundred sixty-one patients met the inclusion criteria, 1302 (83.4%) of which had lower extremity injuries and 259 (16.6%) experienced hip/pelvis trauma. A total of 1001 (64.1%) patients presented with a CCI score of 1 and stayed an average of 7.9 days. Patients with a CCI of 3 experienced a mean LOS of 1.2 days longer than patients presenting with a CCI of 1, whereas patients presenting with a CCI score of 5 stayed an average of 4.6 days longer. After controlling for age, race, American Society of Anesthesiologists score, sex, anesthesia type, and anesthesia time, a higher preoperative CCI was found to be associated with longer LOS for patients with lower extremity fractures (Incidence Rate Ratio: 1.04, P = 0.01). No significant association was found between CCI and LOS for patients with hip/pelvic fractures. CONCLUSIONS This study demonstrated the potential utility of the CCI as a predictor of hospital LOS for lower extremity patients; however, the association may be small given the smaller Incidence Rate Ratio value. Further studies are needed to clarify the predictive value of the CCI for different types of orthopaedic injuries. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete.

  • relationship between the Charlson Comorbidity Index and cost of treating hip fractures implications for bundled payment
    Journal of Orthopaedics and Traumatology, 2015
    Co-Authors: Daniel J Johnson, Sarah E Greenberg, Vasanth Sathiyakumar, Rachel V Thakore, Jesse M Ehrenfeld, William T Obremskey, Manish K Sethi
    Abstract:

    The aim of this study is to investigate how the Charlson Comorbidity Index (CCI) scores contribute to increased length of stay (LOS) and healthcare costs in hip fracture patients. Through retrospective analysis at an Urban level I trauma center, charts for all patients over the age of 60 years who presented with low-energy hip fracture were evaluated. 615 patients who underwent operative fixation of hip fracture or hemiarthroplasty secondary to hip fracture were identified using Current Procedural Terminology (CPT) codes search and included in the study. Data was collected on patient demographics, medical comorbidities, and hospitalization length; from this, the CCI score and the cost to the institution (with an average cost/day of inpatient stay of $4,530) were calculated. Multivariate linear regression analysis modeled the length of stay as a function of CCI score. Each unit increase in the CCI score corresponded to an increase in length of hospital stay and hospital costs incurred [effect size = 0.21; (0.0434–0.381); p = 0.014]. Patients with a CCI score of 2 (compared to a baseline CCI score of 0), on average, stayed 1.92 extra days in the hospital, and incurred $8,697.60 extra costs. The CCI score is associated with length of stay and hospital costs incurred following treatment for hip fracture. The CCI score may be a useful tool for risk assessment in bundled payment plans. Level III.

Hude Quan - One of the best experts on this subject based on the ideXlab platform.

  • developing an adapted Charlson Comorbidity Index for ischemic stroke outcome studies
    BMC Health Services Research, 2019
    Co-Authors: Hude Quan, Ruth Hall, Joan Porter, Mathew J Reeves
    Abstract:

    The Charlson Comorbidity Index (CCI) is commonly used to adjust for patient casemix. We reevaluated the CCI in an ischemic stroke (IS) cohort to determine whether the original seventeen comorbidities and their weights are relevant. We identified an IS cohort (N = 6988) from the Ontario Stroke Registry (OSR) who were discharged from acute hospitals (N = 100) between April 1, 2012 and March 31, 2013. We used hospital discharge ICD-10-CA data to identify Charlson comorbidities. We developed a multivariable Cox model to predict one-year mortality retaining statistically significant (P < 0.05) comorbidities with hazard ratios ≥1.2. Hazard ratios were used to generate revised weights (1–6) for the comorbid conditions. The performance of the IS adapted Charlson Comorbidity Index (ISCCI) mortality model was compared to the original CCI using the c-statistic and continuous Net Reclassification Index (cNRI). Ten of the 17 Charlson comorbid conditions were retained in the ISCCI model and 7 had reassigned weights when compared to the original CCI model . The ISCCI model showed a small but significant increase in the c-statistic compared to the CCI for 30-day mortality (c-statistic 0.746 vs. 0.732, p = 0.009), but no significant increase in c-statistic for in-hospital or one-year mortality. There was also no improvement in the cNRI when the ISCCI model was compared to the CCI. The ISCCI model had similar performance to the original CCI model. The key advantage of the ISCCI model is it includes seven fewer comorbidities and therefore easier to implement in situations where coded data is unavailable.

  • updating and validating the Charlson Comorbidity Index and score for risk adjustment in hospital discharge abstracts using data from 6 countries
    American Journal of Epidemiology, 2011
    Co-Authors: Hude Quan, Chantal Marie Couris, Kiyohide Fushimi, Patrick Graham, Phil Hider, Jeanmarie Januel, Vijaya Sundararajan
    Abstract:

    With advances in the effectiveness of treatment and disease management, the contribution of chronic comorbid diseases (comorbidities) found within the Charlson Comorbidity Index to mortality is likely to have changed since development of the Index in 1984. The authors reevaluated the Charlson Index and reassigned weights to each condition by identifying and following patients to observe mortality within 1 year after hospital discharge. They applied the updated Index and weights to hospital discharge data from 6 countries and tested for their ability to predict in-hospital mortality. Compared with the original Charlson weights, weights generated from the Calgary, Alberta, Canada, data (2004) were 0 for 5 comorbidities, decreased for 3 comorbidities, increased for 4 comorbidities, and did not change for 5 comorbidities. The C statistics for discriminating in-hospital mortality between the new score generated from the 12 comorbidities and the Charlson score were 0.825 (new) and 0.808 (old), respectively, in Australian data (2008), 0.828 and 0.825 in Canadian data (2008), 0.878 and 0.882 in French data (2004), 0.727 and 0.723 in Japanese data (2008), 0.831 and 0.836 in New Zealand data (2008), and 0.869 and 0.876 in Swiss data (2008). The updated Index of 12 comorbidities showed good-to-excellent discrimination in predicting in-hospital mortality in data from 6 countries and may be more appropriate for use with more recent administrative data.

  • updating and validating the Charlson Comorbidity Index and score for risk adjustment in hospital discharge abstracts using data from 6 countries
    American Journal of Epidemiology, 2011
    Co-Authors: Hude Quan, Chantal Marie Couris, Kiyohide Fushimi, Patrick Graham, Phil Hider, Jeanmarie Januel, Bing Li, Vijaya Sundararajan
    Abstract:

    With advances in the effectiveness of treatment and disease management, the contribution of chronic comorbid diseases (comorbidities) found within the Charlson Comorbidity Index to mortality is likely to have changed since development of the Index in 1984. The authors reevaluated the Charlson Index and reassigned weights to each condition by identifying and following patients to observe mortality within 1 year after hospital discharge. They applied the updated Index and weights to hospital discharge data from 6 countries and tested for their ability to predict in-hospital mortality. Compared with the original Charlson weights, weights generated from the Calgary, Alberta, Canada, data (2004) were 0 for 5 comorbidities, decreased for 3 comorbidities, increased for 4 comorbidities, and did not change for 5 comorbidities. The C statistics for discriminating in-hospital mortality between the new score generated from the 12 comorbidities and the Charlson score were 0.825 (new) and 0.808 (old), respectively, in Australian data (2008), 0.828 and 0.825 in Canadian data (2008), 0.878 and 0.882 in French data (2004), 0.727 and 0.723 in Japanese data (2008), 0.831 and 0.836 in New Zealand data (2008), and 0.869 and 0.876 in Swiss data (2008). The updated Index of 12 comorbidities showed good-to-excellent discrimination in predicting in-hospital mortality in data from 6 countries and may be more appropriate for use with more recent administrative data. Comorbidity; International Classification of Diseases; mortality; quality of health care; risk adjustment

  • new icd 10 version of the Charlson Comorbidity Index predicted in hospital mortality
    Journal of Clinical Epidemiology, 2004
    Co-Authors: Vijaya Sundararajan, Hude Quan, Toni Henderson, Catherine Perry, Amanda Muggivan, William A Ghali
    Abstract:

    Abstract Background and objective The ICD-9-CM adaptation of the Charlson Comorbidity score has been a valuable resource for health services researchers. With the transition into ICD-10 coding worldwide, an ICD-10 version of the Deyo adaptation was developed and validated using population-based hospital data from Victoria, Australia. Methods The algorithm was translated from ICD-9-CM into ICD-10-AM (Australian modification) in a multistep process. After a mapping algorithm was used to develop an initial translation, these codes were manually examined by the coding experts and a general physician for face validity. Because the ICD-10 system is country specific, our goal was to keep many of the translated code at the three-digit level for generalizability of the new Index. Results There appears to be little difference in the distribution of the Charlson Index score between the two versions. A strong association between increasing Index scores and mortality exists: the area under the ROC curve is 0.865 for the last year using the ICD-9-CM version and remains high, at 0.855, for the ICD-10 version. Conclusion This work represents the first rigorous adaptation of the Charlson Comorbidity Index for use with ICD-10 data. In comparison with a well-established ICD-9-CM coding algorithm, it yields closely similar prevalence and prognosis information by Comorbidity category.

  • adapting the Charlson Comorbidity Index for use in patients with esrd
    American Journal of Kidney Diseases, 2003
    Co-Authors: Brenda R Hemmelgarn, Hude Quan, Braden J Manns, William A Ghali
    Abstract:

    Abstract Background: Accurate prediction of survival for patients with end-stage renal disease (ESRD) and multiple comorbid conditions is difficult. In nondialysis patients, the Charlson Comorbidity Index has been used to adjust for Comorbidity. The purpose of this study is to assess the validity of the Charlson Index in incident dialysis patients and modify the Index for use specifically in this patient population. Methods: Subjects included all incident hemodialysis and peritoneal dialysis patients starting dialysis therapy between July 1, 1999, and November 30, 2000. These 237 patients formed a cohort from which new integer weights for Charlson comorbidities were derived using Cox proportional hazards modeling. Performance of the original Charlson Index and the new ESRD Comorbidity Index were compared using Kaplan-Meier survival curves, change in likelihood ratio, and the c statistic. Results: After multivariate analysis and conversion of hazard ratios to Index weights, only 6 of the original 18 Charlson variables were assigned the same weight and 6 variables were assigned a weight higher than in the original Charlson Index. Using Kaplan-Meier survival curves, we found that both the original Charlson Index and the new ESRD Comorbidity Index were associated with and able to describe a wide range of survival. However, the new study-specific Index had better validated performance, indicated by a greater change in the likelihood ratio test and higher c statistic. Conclusion: This study indicates that the original Charlson Index is a valid tool to assess Comorbidity and predict survival in patients with ESRD. However, our modified ESRD Comorbidity Index had slightly better performance characteristics in this population.