Accordion complication grading predicts short-term outcome after right colectomy

Coen L. Klos, Bashar Safar, Steven R. Hunt, Paul E. Wise, Elisa H. Birnbaum, Matthew G. Mutch, James W. Fleshman, Sekhar Dharmarajan

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


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.

Original languageEnglish
Pages (from-to)510-516
Number of pages7
JournalJournal of Surgical Research
Issue number2
StatePublished - Aug 2014


  • Colorectal
  • Complications
  • Morbidity
  • Mortality
  • Outcome
  • Surgery


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