A Comparison of the Charlson and Elixhauser Methods for Predicting Nursing Indicators in Gastrectomy with Gastric Cancer Patients

Round 1

Reviewer 1 Report

The proposed study compares the comorbidity indices of Charlson (CCI) and  Elixhauser (ECI)  for ability to predict nursing sensitive outcomes. 

Some editing is especially necessary for citations where a question mark often appears into reference [14?16] as in line 52 and 62, and in discussing results as in line 162 (with?p?< 0.05.?). Editing should also be done for referencing style as in lines 64 to 67.

Some perplexities concern the content, in particular:

1. The Database is almost 8 years old: why did the authors use that particular year? How much is still valid today? The authors were supposed to give a description of stomach cancer epidemiology 20016 versus 2022 but no justifications or comparisons are provided.

2. In the statistical analysis there is perhaps redundancy of description in two large tables; perhaps a summary of the significant elements using a graph-like representation would improve readability. In particular, I believe that in this type of comparison it would be useful to use the ROC Curve statistics to better represent the predictive capacity of a scale.

3. I think the authors were slow to discuss the significance of the findings in relation to the stated goals of the study. In particular, the relationship between potential complications and sensitive nursing outcomes. Indeed, the authors conclude that "Because accurate prediction and prevention of postoperative complications can improve patient outcomes and nursing quality, consideration should be given to using ECI to predict complications in the hospital after surgery surgical". I believe that the link between assessment of comorbidities, postoperative risk, and nursing outcomes needs to be better clarified in the light of the findings. Otherwise, all will come down to a comparative assessment between scales and significance for the development of nursing science for best practice remains foggy and not clarified.

Overall, the work is well structured and presents a further clinical dimension investigated in order to evaluate the Charlson's (CCI) and Elixhauser's (ECI) indices. Such indices are already extensively evaluated in other clinical fields as correctly reported in the bibliography.

  The weakest part of the paper concerns the discussion of the significance for nursing and how much these results may or may not relate to the specific nursing outcomes for the specific clinical cases.

 

There are some question marks in the text as if it were still a draft under review, but otherwise well written

Author Response

Thank you for your thoughtful suggestions and insights, which have enriched the manuscript and produced a more balanced and better account of the research. We have carefully rechecked the relevant section and made appropriate changes in accordance with the suggestions of the reviewers. Revised sections are written in blue within the document. Please, see the attached file for the detail.

Author Response File: Author Response.pdf

Reviewer 2 Report

Overall, the impression of the necessity and importance of this study in patient care seems to be somewhat weak. The following are the corrections to be made in the introduction and discussion.

 

• In the introduction part, the need for patient care in this study should be clearly presented. In other words, I think it should be mentioned how predicting nursing indicators by comparing comorbidity indications is useful for patient care. Consideration of prior research related to this should be presented

 

• In addition, the discussion needs to show how the results of this study contribute to improving health care quality. In this context, the significance of this study should be presented.

 

• Some details need to be revised and supplemented.

1) Modifications required in the text

Introduction: [14?16]  [19?24].

Statistical Analysis: with?p?< 0.05.?T

2) Please put foot notes on the abbreviations used in the tables.

3) What does asterisk mean below?

Table3: C stat*

Thank you for your effort.

Author Response

Thank you for your thoughtful suggestions and insights, which have enriched the manuscript and produced a more balanced and better account of the research. We have carefully rechecked the relevant section and made appropriate changes in accordance with the suggestions of the reviewers. Revised sections are written in blue within the document. Please, see the attached file for the detail.

Author Response File: Author Response.pdf