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Analyzing Impact of Multimorbidity on Long-Term Outcomes after Emergency General Surgery: A Retrospective Observational Cohort Study.
- Source :
-
Journal of the American College of Surgeons (2563-9021) . Nov2022, Vol. 235 Issue 5, p724-735. 12p. - Publication Year :
- 2022
-
Abstract
- BACKGROUND: Little is known about the impact of multimorbidity on long-term outcomes for older emergency general surgery patients. STUDY DESIGN: Medicare beneficiaries, age 65 and older, who underwent operative management of an emergency general surgery condition were identified using Centers for Medicare & Medicaid claims data. Patients were classified as multimorbid based on the presence of a Qualifying Comorbidity Set (a specific combination of comorbid conditions known to be associated with increased risk of in-hospital mortality in the general surgery setting) and compared with those without multimorbidity. Risk-adjusted outcomes through 180 days after discharge from index hospitalization were calculated using linear and logistic regressions. RESULTS: Of 174,891 included patients, 45.5% were identified as multimorbid. Multimorbid patients had higher rates of mortality during index hospitalization (5.9% vs 0.7%, odds ratio [OR] 3.05, p < 0.001) and through 6 months (17.1% vs 3.4%, OR 2.33, p < 0.001) after discharge. Multimorbid patients experienced higher rates of readmission at 1 month (22.9% vs 11.4%, OR 1.48, p < 0.001) and 6 months (38.2% vs 21.2%, OR 1.48, p < 0.001) after discharge, lower rates of discharge to home (42.5% vs 74.2%, OR 0.52, p < 0.001), higher rates of discharge to rehabilitation/nursing facility (28.3% vs 11.3%, OR 1.62, p < 0.001), greater than double the use of home oxygen, walker, wheelchair, bedside commode, and hospital bed (p < 0.001), longer length of index hospitalization (1.33 additional in-patient days, p < 0.001), and higher costs through 6 months ($5,162 additional, p < 0.001). CONCLUSIONS: Older, multimorbid patients experience worse outcomes, including survival and independent function, after emergency general surgery than nonmultimorbid patients through 6 months after discharge from index hospitalization. This information is important for setting recovery expectations for high-risk patients to improve shared decision-making. [ABSTRACT FROM AUTHOR]
- Subjects :
- *SCIENTIFIC observation
*ANALYSIS of variance
*OPERATIVE surgery
*RETROSPECTIVE studies
*REGRESSION analysis
*MEDICAL emergencies
*TREATMENT effectiveness
*HOSPITAL mortality
*POSTOPERATIVE period
*DECISION making
*DESCRIPTIVE statistics
*KAPLAN-Meier estimator
*LOGISTIC regression analysis
*ODDS ratio
*COMORBIDITY
*MEDICARE
*GOAL (Psychology)
*OLD age
Subjects
Details
- Language :
- English
- ISSN :
- 25639021
- Volume :
- 235
- Issue :
- 5
- Database :
- Academic Search Index
- Journal :
- Journal of the American College of Surgeons (2563-9021)
- Publication Type :
- Academic Journal
- Accession number :
- 160789334
- Full Text :
- https://doi.org/10.1097/XCS.0000000000000303