The Application of Comorbidity Indices to Predict Early Postoperative Outcomes After Laparoscopic Roux-en-Y Gastric Bypass: A Nationwide Comparative Analysis of Over 70,000 Cases

BACKGROUND: 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. METHODS: 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). RESULTS: 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. CONCLUSIONS: 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.

Die Geschichte der Juden in Palästina seit dem Jahre 70 nach Chr. : eine Skizze

von G. Hölscher

Die Geschichte der "Königswarter-Stiftung" in Meran 1872 - 1907 : [... Rafael Hausmann zur Feier seines 70. Geburtstages ...]

von A.Tänzer

Festschrift Professor Dr. Maybaum zum 70. Geburtstag : (29. April 1914)

gewidmet von seinen Schülern

Festskrift i anledning af Professor David Simonsens 70-aarige Fødselsdag

Nir Daṿid likhvod ha-rav he-ḥakham R. Daṿid Simonsen

Festschrift zum 70. Geburtstage des Oberkirchenrats Dr. Kroner

hrsg. vom Württemberg. Rabbiner-Verein

Festschrift zu Ehren des Dr. A. Harkavy aus Anlass seines am 20. November 1905 vollendeten 70. Lebensjahre : gewidmet von Freunden und Verehrern

Hrsg. von Baron D. von Günzburg

Treu und frei : ges. Reden u. Vorträge über Juden u. Judentum von M. Lazarus : [mit] Lebensbild zu seinem 70. Geburtstage am 15. Sept. 1894

von M. Brasch

Festschrift zum 70. Geburtstag von Moritz Schaefer : zum 21. Mai 1927

hrsg. von ... Philipp Aronstein [u.a.]

Isak Noa Mannheimer, Prediger : eine biographische Skizze ; mit Benützung von Archivalien d. k.k. Staats- u. Justizministerien, d. k.k. obersten Gerichtshofes, d. k.k. niederösterreichischen Statthalterei u. d. Wiener Magistrates (zur Feier d. 70. Geburtstages, am 17. Oct. 1863)

von G. Wolf

Types of Jewish-Palestinian piety : from 70 B.C.E. to 70 C.E. ; the ancient pious men

by Adolph Büchler