Utility of the Charlson Comorbidity Index in the Preoperative Evaluation of Patients Undergoing Cardiac Surgery

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INTRODUCTION: The Charlson Comorbidity Index (CCI) is used for assessing comorbidities and estimating risk of adverse outcomes in surgical patients. In cardiac surgery, the burden of comorbidities can significantly influence incidence of postoperative complications and mortality. This study evaluates the utility of CCI in predicting perioperative complications in patients undergoing cardiac surgery. METHODS: Observational cross-sectional study with retrospective data including 483 adult patients who underwent cardiac surgery with cardiopulmonary bypass at the Instituto Nacional de Cardiología Ignacio Chávez from June 2022 to December 2023. Patients were grouped by preoperative CCI: mild (0 - 1), moderate (2), and severe (≥ 3). Statistical analyses (chi-square, Mann-Whitney U, logistic regression) assessed the association between CCI and postoperative complications, adjusting for age and sex. RESULTS: Patients with severe comorbidity had higher rates of postoperative complications, including delirium (27.3% vs. 9.4%, P = 0.00), stroke (P = 0.03), transfusion (69.7% vs. 47.2%, P = 0.04), and renal replacement therapy (18.2% vs. 5.3%, P = 0.02). Median Sequential Organ Failure Assessment scores at 24 hours were significantly higher (P = 0.00). Logistic regression adjusted for age, sex, and coronary artery bypass grafting identified delirium (odds ratio [OR]: 3.13), nosocomial pneumonia (OR: 3.10), acute kidney injury (OR: 2.28), and renal replacement therapy (OR: 4.10) as independent predictors of severe comorbidity. CONCLUSIONS: The CCI is a valuable tool for predicting postoperative complications in patients undergoing cardiac surgery. Early identification of comorbidities is essential for perioperative planning and optimizing clinical outcomes. Integrating the CCI into routine clinical practice is recommended to enhance patient management.

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