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, 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

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.

Keywords: EPIDEMIOLOGY; GERIATRIC MEDICINE; Multimorbidity; SURGERY.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Figures

Figure 1
Figure 1
Conditions used to define multimorbidity.

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