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Invited Critique
Aug 2011

Is Risk Calculation Risky?Comment on “Risk of Comorbidities on Postoperative Outcomes in Patients With Inflammatory Bowel Disease”

Author Affiliations

Author Affiliation: Surgical Outcomes Analysis & Research (SOAR), University of Massachusetts Medical School, Worcester.

Arch Surg. 2011;146(8):964-965. doi:10.1001/archsurg.2011.185

In this issue of the Archives of Surgery, Kaplan et al1 use the Nationwide Inpatient Sample, a large administrative database, to analyze the association of various coded conditions on inpatient mortality rate, length of stay, and hospital charges after operations on patients with Crohn disease or ulcerative colitis. The authors have found that an increasing number of comorbid conditions lead to worse outcomes. For example, as diagrammed in the Figure, performing an elective operation on a young patient with no comorbidities might convey an average in-hospital mortality of 0.1%, but an emergency admission and subsequent operation on an elderly patient with at least 2 comorbidities might assume a 20.6% mortality risk.