Defining Multimorbidity in Older Surgical Patients

Silber, Jeffrey H.; Reiter, Joseph G; Rosenbaum, Paul R.; Zhao, Qingyuan; Small, Dylan S.; Niknam, Bijan A.; Hill, Alexander S.; Hochman, Lauren L.; Kelz, Rachel R.; Fleisher, Lee A.

doi:10.1097/mlr.0000000000000947

Cited by 25 publications

(47 citation statements)

References 46 publications

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“…Multimorbidity is more than just the presence of multiple comorbidities, but the interaction of chronic conditions. 7,33,38 Meraya et al 39 found that health expenditures vary based on different combinations of chronic comorbid conditions and Cooper et al 40 found certain comorbidities (renal failure, dementia, and congestive heart failure) to be associated with increased 30-day, 180-day, and 365-day mortality after emergency abdominal surgery (but did not analyze specific combinations of comorbidities). Ho et al 19 in 2019 examined whether specific comorbidities increased risk of mortality after emergency general surgery and found that specific combinations of comorbidities were associated with disproportionate mortality.…”

Section: Discussionmentioning

confidence: 99%

“…This study is the first application of the QCS definition of multimorbidity developed by Silber et al 7 to emergency general surgery. This is important for 2 reasons: the first is that the QCSs developed by Silber and colleagues have been shown to be associated with higher risks of mortality after general surgery procedures when compared with the average general surgery population, and thus can be used as a powerful tool to stratify patient risk and should be implemented into further research.…”

Section: Discussionmentioning

confidence: 99%

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Multimorbidity Confers Greater Risk for Older Patients in Emergency General Surgery Than the Presence of Multiple Comorbidities

Rosen

Wirtalla²,

Keele³

et al. 2022

Medical Care

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Multimorbidity Confers Greater Risk for Older Patients in Emergency General Surgery Than the Presence of Multiple Comorbidities

Rosen

Wirtalla²,

Keele³

et al. 2022

Medical Care

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“…The presence of two or more chronic diseases is known as multi-morbidity, which is associated with decreased quality of life, functional decline, and increased healthcare utilization [ 6 ]. A systematic review estimated the pooled prevalence of multi-morbidity at 33.1% worldwide, with the prevalence being 37.9% in high-income countries and 29.7% in low- to middle-income countries [ 7 ]. For comparison, a local study amongst community dwellers in Singapore estimates its prevalence at 26.2% and found that it was associated with increasing age, female gender, lower socioeconomic status, and an increasing number of mental disorders [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

Association of Multimorbidity With Frailty in Older Adults for Elective Non-Cardiac Surgery

Au-Yong¹,

Sim²,

Ho³

et al. 2021

Cureus

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IntroductionFrailty is associated with adverse surgical outcomes. While existing studies describe the prevalence of multimorbidity and frailty in the community, the surgical population may have more severe disease and significant surgical stress. This study aims to describe the distribution of frailty and multimorbidity in the older surgical population and examine if specific comorbidities are more strongly associated with frailty. MethodsThis is a single-centre retrospective cohort study using an electronic database in the preoperative evaluation clinic, conducted in Singapore General Hospital, Singapore. All patients above 70 years old going for elective non-cardiac surgery were included. Demographics and comorbidities were analysed for their association with frailty according to the Edmonton Frail Scale. ResultsA total of 1396 out of 1398 patients were analyzed. The overall incidence of frailty was 27.8% and multimorbidity was 63.4%. Factors independently associated with frailty were age (adjusted Odds Ratio [aOR] = 1.07), female gender (aOR = 1.67), type 2 diabetes mellitus (aOR = 1.69), chronic kidney disease (aOR = 1.47), end-stage renal failure (aOR = 3.58), history of cerebrovascular accident or transient ischemic attack (aOR = 1.87), moderate anaemia (aOR = 2.11), dementia (aOR = 6.38), depression (aOR = 3.82), and peptic ulcer disease (aOR = 1.98). The presence of multi-morbidity was significantly associated with frailty, with overall increasing strength of association. ConclusionAs the number of comorbidities increases, the odds of frailty increase. Only a small proportion of those with multimorbidity accumulate enough biological deficits to develop frailty, putting them at higher risk than with solely multimorbidity or frailty. Dementia and depression are comorbidities with strong associations that have yet to see coordinated interventional efforts in the preoperative setting.

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“…Frail patients tend to be accompanied by multimorbidity; 13 studies showed that surgical patients with multimorbidity had a much higher risk of death than those without multimorbidity. 14 Surgery is a major physiological stress in patients with frailty who are vulnerable to stressors and have a decreased physiologic reserve. 15 This implies that frail patients have a limited ability to cope with and recover from surgery, and are vulnerable to adverse outcomes.…”

Section: Introductionmentioning

confidence: 99%

Frailty and Adverse Outcomes Among Older Patients Undergoing Gastroenterological Surgery in Vietnam

Nguyen

Pham

2021

JMDH

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Purpose With the ageing population, more older adults undergo surgery, and frailty increases the risk of postoperative complications in older patients. This study aimed to determine the association between frailty and 30-day adverse outcomes in older patients undergoing gastroenterological surgery in Vietnam. Patients and Methods A prospective cohort study was conducted in the Gastroenterology Department of the University Medical Center in Ho Chi Minh City. Frailty was determined using Fried’s criteria. Adverse outcomes within 30 days of gastroenterological surgery were recorded, including postoperative infections, acute respiratory failure, acute kidney injury, and death. Univariate and multivariate logistic analyses were performed to determine the association between frailty and 30-day postoperative adverse outcomes using Stata 14.0. Results Data of 302 elective surgical participants were collected (mean age: 69.8± 8.1 years, 53.3% female), and the prevalence of frailty was 18.5%. Frailty was an independent risk factor for 30-day adverse outcomes (odds ratio=6.56, 95% confidence interval, 2.77–15.53, p <0.001), which included postoperative infections, acute respiratory failure, acute kidney injury, and death. Frail participants had a significantly higher risk of postoperative infections (odds ratio=8.21, 95% confidence interval, 3.28–20.54, p <0.001), and exhaustion was strongly associated with postoperative adverse outcomes. Conclusion Frailty was a predictor of 30-day adverse outcomes in older patients undergoing gastroenterological surgery. Therefore, preoperative frailty should be screened in older patients, and frailty-associated risks should be considered during the decision-making process by physicians, patients, and their families.

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Defining Multimorbidity in Older Surgical Patients

Abstract: A list of QCSs identified a third of older patients undergoing general surgery that had greatly elevated mortality. These sets can be used to identify vulnerable patients and the specific combinations of comorbidities that make them susceptible to poor outcomes.

Cited by 25 publications

References 46 publications

Multimorbidity Confers Greater Risk for Older Patients in Emergency General Surgery Than the Presence of Multiple Comorbidities

Multimorbidity Confers Greater Risk for Older Patients in Emergency General Surgery Than the Presence of Multiple Comorbidities

Association of Multimorbidity With Frailty in Older Adults for Elective Non-Cardiac Surgery

Frailty and Adverse Outcomes Among Older Patients Undergoing Gastroenterological Surgery in Vietnam

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