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

doi:10.1136/bmjopen-2015-010126

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 language	English
Article number	e010126
Pages (from-to)	1-7
Number of pages	7
Journal	BMJ Open
Volume	6
Issue number	3
Early online date	31 Mar 2016
DOIs	https://doi.org/10.1136/bmjopen-2015-010126
Publication status	Published - Mar 2016

Bibliographical note

Funding: This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

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Prevalence of multimorbidity and its association with outcomes in older emergency general surgical patients: an observational study
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/
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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. Article e010126. https://doi.org/10.1136/bmjopen-2015-010126

@article{6a342eead9ea4af1a671b70b3a7a4014,

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

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.",

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

note = "Funding: This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.",

year = "2016",

month = mar,

doi = "10.1136/bmjopen-2015-010126",

language = "English",

volume = "6",

pages = "1--7",

journal = "BMJ Open",

issn = "2044-6055",

publisher = "BMJ Publishing Group",

number = "3",

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TY - JOUR

T1 - Prevalence of multimorbidity and its association with outcomes in older emergency general surgical patients

T2 - an observational study

AU - Hewitt, Jonathan

AU - McCormack, Caroline

AU - Tay, Hui Sian

AU - Greig, Matthew

AU - Law, Jennifer

AU - Tay, Adam

AU - Asnan, Nurwasimah Hj

AU - Carter, Ben

AU - Myint, Phyo Kyaw

AU - Pearce, Lyndsay

AU - Moug, Susan J.

AU - McCarthy, Kathryn

AU - Stechman, Michael J.

N1 - Funding: This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

PY - 2016/3

Y1 - 2016/3

N2 - 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.

AB - 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.

U2 - 10.1136/bmjopen-2015-010126

DO - 10.1136/bmjopen-2015-010126

M3 - Article

C2 - 27033960

SN - 2044-6055

VL - 6

SP - 1

EP - 7

JO - BMJ Open

JF - BMJ Open

IS - 3

M1 - e010126

ER -

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

Abstract

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