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

Cardiff University
Aberdeen Royal Infirmary
Manchester Royal Infirmary
Royal Alexandra Hospital, Paisley
North Bristol NHS Trust
University Hospital of Wales

Research output: Contribution to journal › Article › peer-review

73 Citations (Scopus)

12 Downloads (Pure)

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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Cite this

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",

}

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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