Prevalence of multimorbidity and its association with outcomes in older emergency general surgical patients: an observational study

Jonathan Hewitt, Caroline McCormack, Hui Sian Tay, Matthew Greig, Jennifer Law, Adam Tay, Nurwasimah Hj Asnan, Ben Carter, Phyo Kyaw Myint, Lyndsay Pearce, Susan J. Moug, Kathryn McCarthy, Michael J. Stechman

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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.

Original languageEnglish
Article numbere010126
Pages (from-to)1-7
Number of pages7
JournalBMJ Open
Volume6
Issue number3
Early online date31 Mar 2016
DOIs
Publication statusPublished - Mar 2016

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    Hewitt, J., McCormack, C., Tay, H. S., Greig, M., Law, J., Tay, A., Asnan, N. H., Carter, B., Myint, P. K., Pearce, L., Moug, S. J., McCarthy, K., & Stechman, M. J. (2016). Prevalence of multimorbidity and its association with outcomes in older emergency general surgical patients: an observational study. BMJ Open, 6(3), 1-7. [e010126]. https://doi.org/10.1136/bmjopen-2015-010126