Accordion complication grading predicts short-term outcome after right colectomy

• Published in: The Journal of surgical research 2014-08, Vol.190 (2), p.510-516
• Main Authors: Klos, Coen L., MD, Safar, Bashar, MD, Hunt, Steven R., MD, Wise, Paul E., MD, Birnbaum, Elisa H., MD, Mutch, Matthew G., MD, Fleshman, James W., MD, Dharmarajan, Sekhar, MD
• Format: Article
• Language: English
• Subjects: Adenocarcinoma - mortality; Adenocarcinoma - surgery; Aged; Colectomy - adverse effects; Colectomy - mortality; Colonic Neoplasms - mortality; Colonic Neoplasms - surgery; Colorectal; Complications; Female; Forecasting; Humans; Length of Stay - statistics & numerical data; Male; Morbidity; Mortality; Outcome; Patient Readmission - statistics & numerical data; Postoperative Complications - mortality; Retrospective Studies; Severity of Illness Index; Surgery; Treatment Outcome
• ISSN: 0022-4804; 1095-8673
• DOI: 10.1016/j.jss.2013.11.1084

Abstract Background The Accordion severity grading system is a novel system to score the severity of postoperative complications in a standardized fashion. This study aims to demonstrate the validity of the Accordion system in colorectal surgery by correlating severity grades with short-term outcomes after right colectomy for colon cancer. Methods This is a retrospective cohort review of patients who underwent right colectomy for cancer between January 1, 2002, and January 31, 2007, at a single tertiary care referral center. Complications were categorized according to the Accordion severity grading system: grades 1 (mild), 2 (moderate), 3–5 (severe), and 6 (death). Outcome measures were hospital stay, 30-d readmission rate and 1-y survival. Correlation between Accordion grades and outcome measures is reflected by Spearman rho (ρ). One-year survival was obtained per Kaplan-Meier method and compared by logrank test for trend. Significance was set at P ≤ 0.05. Results Overall, 235 patients underwent right colectomy for cancer of which 122 (51.9%) had complications. In total, 52 (43%) had an Accordion grade 1 complication; 44 (36%) grade 2; four (3%) grade 3; 11 (9%) grade 4; seven (6%) grade 5; and four (3%) grade 6. There was significant correlation between Accordion grades and hospital stay (ρ = 0.495, P < 0.001) and 30-d readmission rate (ρ = 0.335, P < 0.001). There was a significant downward trend in 1-y survival as complication severity by Accordion grade increased ( P = 0.02). Conclusions The Accordion grading system is a useful tool to estimate short-term outcomes after right colectomy for cancer. High-grade Accordion complications are associated with longer hospital stay and increased risk of readmission and mortality.