Accordion complication grading predicts short-term outcome after right colectomy.
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.
Section of Colon and Rectal Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri.
Coen L
CL
Klos
Section of Colon and Rectal Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri; Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Bashar
B
Safar
Section of Colon and Rectal Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri.
Steven R
SR
Hunt
Section of Colon and Rectal Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri.
Paul E
PE
Wise
Section of Colon and Rectal Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri.
Elisa H
EH
Birnbaum
Section of Colon and Rectal Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri.
Matthew G
MG
Mutch
Section of Colon and Rectal Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri; Department of Surgery, Baylor University Medical Center, Dallas, Texas.
James W
JW
Fleshman
Section of Colon and Rectal Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri. Electronic address: dharmarajans@wudosis.wustl.edu.
Sekhar
S
Dharmarajan
D000230:Adenocarcinoma / Q000401:mortality / Q000601:surgery*; D000368:Aged; D003082:Colectomy / Q000009:adverse effects* / Q000401:mortality; D003110:Colonic Neoplasms / Q000401:mortality / Q000601:surgery*; D005260:Female; D005544:Forecasting; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D010359:Patient Readmission / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000401:mortality; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome
Colorectal; Complications; Morbidity; Mortality; Outcome; Surgery