Impact of comorbidity on outcome among acute non-traumatic surgical patients. Evaluation of Charlson comorbidity index

Objectives: To determine the prevalence of comorbid conditions among acute non-traumatic general surgery patients. To assess the impact of comorbidity on outcomes and evaluate the effectiveness of using Charlson comorbidity index (CCI) in these patients. Methods: All acute non-traumatic general surgery patients admitted to King Saud Medical Complex, Riyadh, Saudi Arabia, between January 1, 2007 and December 31, 2007 were included (n=1296). Patient data were explored to record comorbidity, and the CCI score calculated. The length of hospital stay, post-operative complications and mortality were recorded as outcome measures. The outcomes in patients with comorbid conditions were compared with patients without comorbid conditions. Results: We found one or more comorbid conditions in 31.9% (n=414) patients. The CCI score ranged from 1-8. All 3 outcome measures were recorded significantly higher in patients with comorbidity compared to patients with no comorbid condition; length of stay, 17.3 versus 10.6 days (p 0.0001), post-operative complications 46.3% versus 31% (p 0.0001), mortality 7.7% versus 4.4% (p 0.0001). Severe comorbidity as indicated by higher CCI score significantly correlated with length of stay, r=0.30 (p 0.0001) and mortality, r=0.2645 (p 0.0001). Overall risk of mortality was 1.81 times higher with comorbidity (odds ratio 1.81, 95% confidence interval 1.087-3.012, p=0.0182). Conclusion: Comorbidity caused increased hospital stay, post-operative complications, and mortality among acute non-traumatic general surgery patients. The CCI is a reliable comorbidity index, which can help in managing risks in surgical patients.