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Geriatric medicine
Research
Prevalence of multimorbidity and its association with outcomes in older emergency general surgical patients: an observational study
  1. Jonathan Hewitt1,
  2. Caroline McCormack2,
  3. Hui Sian Tay2,
  4. Matthew Greig2,
  5. Jennifer Law3,
  6. Adam Tay4,
  7. Nurwasimah Hj Asnan4,
  8. Ben Carter1,
  9. Phyo Kyaw Myint2,5,
  10. Lyndsay Pearce3,
  11. Susan J Moug4,
  12. Kathryn McCarthy6,
  13. Michael J Stechman7
  1. 1Division of Population Medicine, Cardiff University, Cardiff, UK
  2. 2Department of Medicine for the Elderly, Aberdeen Royal Infirmary, Aberdeen, UK
  3. 3Department of General Surgery, Manchester Royal Infirmary, Manchester, UK
  4. 4Department of General Surgery, Royal Alexandra Hospital, Paisley, Greater Glasgow, UK
  5. 5Epidemiology Group, Institute of Applied Health Sciences, School of Medicine and Dentistry, University of Aberdeen, Aberdeen, UK
  6. 6Department of General Surgery, North Bristol NHS Trust, Bristol, UK
  7. 7Department of General Surgery, University Hospital of Wales, Cardiff, UK
  1. Correspondence to Dr Jonathan Hewitt; hewittj2{at}cardiff.ac.uk

Abstract

Objectives Multimorbidity is the presence of 2 or more medical conditions. This increasingly used assessment has not been assessed in a surgical population. The objectives of this study were to assess the prevalence of multimorbidity and its association with common outcome measures.

Design A cross-sectional observational study.

Setting A UK-based multicentre study, included participants between July and October 2014.

Participants Consecutive emergency (non-elective) general surgical patients admitted to hospital, aged over 65 years.

Outcome measures The outcome measures were (1) the prevalence of multimorbidity and (2) the association between multimorbidity and frailty; the rate and severity of surgery; length of hospital stay; readmission to hospital within 30 days of discharge; and death at 30 and 90 days.

Results Data were collected on 413 participants aged 65–98 years (median 77 years, (IQR (70–84)). 51.6% (212/413) participants were women. Multimorbidity was present in 74% (95% CI 69.7% to 78.2%) of the population and increased with age (p<0.0001). Multimorbidity was associated with increasing frailty (p for trend <0.0001). People with multimorbidity underwent surgery as often as those without multimorbidity, including major surgery (p=0.03). When comparing multimorbid people with those without multimorbidity, we found no association between length of hospital stay (median 5 days, IQR (1–54), vs 6 days (1–47), (p=0.66)), readmission to hospital (64 (21.1%) vs 18 (16.8%) (p=0.35)), death at 30 days (14 (4.6%) vs 6 (5.6%) (p=0.68)) or 90-day mortality (28 (9.2%) vs 8 (7.6%) (p=0.60)).

Conclusions and implications Multimorbidity is common. Nearly three-quarters of this older emergency general surgical population had 2 or more chronic medical conditions. It was strongly associated with age and frailty, and was not a barrier to surgical intervention. Multimorbidity showed no associations across a range of outcome measures, as it is currently defined. Multimorbidity should not be relied on as a useful clinical tool in guidelines or policies for older emergency surgical patients.

  • GERIATRIC MEDICINE
  • EPIDEMIOLOGY
  • SURGERY
  • Multimorbidity

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bmjopen-2015-010126

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