P0543 - Charlson Comorbidity Index as an Indicator Factor for Worse Outcomes in Patients Undergoing Bariatric Surgery

Denise Nunez, DO¹, Clive J. Miranda, DO, MSc², Gloria Erazo, MD³, Maria Grba, DO¹, Saksham Kohli, MBBS¹, Patricia Zarza Gulino, MD¹, Gedion Yilma Amdetsion, MD⁴, Daniel Guifarro Rivera, MD⁵
1John H. Stroger, Jr. Hospital of Cook County, Chicago, IL; 2CHI Health Creighton University Medical Center, Omaha, NE; 3Texas Tech University Health Sciences Center, Odessa, TX; 4Cook County Health, Chicago, IL; 5Cook County Health and Hospital Systems, Chicago, IL

Introduction: The Charlson Comorbidity Index (CCI) is a validated tool for predicting outcomes based on pre-existing comorbidities. Patients who undergo bariatric surgery commonly present with additional comorbidities such as diabetes, hypertension, and heart disease. This study evaluates the role of CCI in predicting adverse outcomes in patients undergoing elective bariatric surgery (BS), including Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG).

Methods: Patients admitted for either RYGB or SG were identified using the National Inpatient Sample from 2018 to 2019 and combined into a single variable (bariatric surgery). The CCI was evaluated for all patients. Multivariate regression analysis (STATA 18) assessed the role of CCI as a risk factor for outcomes while adjusting for confounders such as age, gender, hospital characteristics, and insurance. Primary outcomes included mortality, while secondary outcomes included other same admission complications.

Results: A total of 382,180 BS patients, of which 117,325 had RYGB and 264,855 had SG, were analyzed. Patients were predominantly white females. (Sociodemographic characteristics are shown in Table 1.) Increasing CCI scores were significantly associated with worse outcomes across all groups as shown in Figure 1. Mortality increased by 24% per CCI point for RYGB (OR=1.24, p< 0.01), 56% for SG (OR=1.56, p< 0.001), and 32% for BS (OR=1.32, p< 0.001). Higher CCI scores reduced the likelihood of early procedures (< 1 day from admission), with 18% lower odds for RYGB (OR=0.82, p< 0.001) and 10% for SG (OR=0.90, p< 0.01). LOS increased with rising CCI, by 0.57 days for RYGB (p< 0.001), 0.08 days for SG (p< 0.001), and 0.39 days for combined surgeries (p< 0.001). Hospital charges similarly rose, with a $7,054 increase per CCI point for RYGB (p< 0.001) and $1,754 for SG (p< 0.001). Complications were also strongly associated with higher CCI scores. Additional same admission complications such as acute kidney injury, pulmonary embolism, respiratory failure, intubation, and vasopressor support are shown in Figure 1.

Discussion: The Charlson Comorbidity Index is a significant predictor of adverse outcomes in bariatric surgery. Patients with higher CCI scores face increased risks of mortality, prolonged LOS, higher hospital costs, and more frequent complications. These findings highlight the importance of thorough preoperative risk assessment and optimization, particularly for high-CCI patients, to mitigate risks and improve bariatric surgery outcomes.


Figure: Table 1. Sociodemographic Characteristics of Patients Admitted for Elective Bariatric Surgery


Figure: Figure 1. Charlson Comorbidity Index and Post-Operatory Same-Admission Outcomes of Patients Undergoing Bariatric Surgery

Disclosures:
Denise Nunez indicated no relevant financial relationships.
Clive Miranda indicated no relevant financial relationships.
Gloria Erazo indicated no relevant financial relationships.
Maria Grba indicated no relevant financial relationships.
Saksham Kohli indicated no relevant financial relationships.
Patricia Zarza Gulino indicated no relevant financial relationships.
Gedion Yilma Amdetsion indicated no relevant financial relationships.
Daniel Guifarro Rivera indicated no relevant financial relationships.

Denise Nunez, DO¹, Clive J. Miranda, DO, MSc², Gloria Erazo, MD³, Maria Grba, DO¹, Saksham Kohli, MBBS¹, Patricia Zarza Gulino, MD¹, Gedion Yilma Amdetsion, MD⁴, Daniel Guifarro Rivera, MD⁵. P0543 - Charlson Comorbidity Index as an Indicator Factor for Worse Outcomes in Patients Undergoing Bariatric Surgery, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.