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

Hewitt, Jonathan; McCormack, Caroline; Tay, H S; Greig, Matthew; Law, Jennifer; Tay, A.; Asnan, Nurwasimah Hj; Carter, Ben; Myint, Phyo Kyaw; Pearce, Lyndsay; Moug, Susan; McCarthy, Kathryn; Stechman, Michael

doi:10.1136/bmjopen-2015-010126

Cited by 71 publications

(63 citation statements)

References 19 publications

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“…This finding is not consistent with previous reports in primary care populations, where multimorbidity is generally more common in females [6,12,24]. Studies reporting the prevalence of multimorbidity by gender in hospitalised populations are limited, and report conflicting results [14,16,47,48]. We also noted some evidence of a different pattern of multimorbidity between males and females at different age groups.…”

Section: Discussioncontrasting

confidence: 99%

Measuring multimorbidity in hospitalised patients using linked hospital episode data: comparison of two measures

Robertson

Ayansina

Johnston

et al. 2019

IJPDS

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IntroductionMultimorbidity is a complex and growing health challenge. There is no accepted “gold standard” multimorbidity measure for hospital resource planning, and few studies have compared measures in hospitalised patients. AimTo evaluate operationalisation of two multimorbidity measures in routine hospital episode data in NHS Grampian, Scotland. MethodsLinked hospital episode data (Scottish Morbidity Record (SMR)) for the years 2009-2016 were used. Adults admitted to hospital as a general/acute inpatient during 2014 were included. Conditions (ICD-10) were identified from general/acute (SMR01) and psychiatric (SMR04) admissions during the five years prior to first admission in 2014. Two count-based multimorbidity measures were used (Charlson Comorbidity Index and Tonelli et al.), and multimorbidity was defined as ≥2 conditions. Kappa statistics assessed agreement. The association between multimorbidity and length of stay, readmission and mortality was assessed using logistic and negative binomial regression as appropriate. ResultsIn 41,545 adults (median age 62 years, 52.6% female), multimorbidity prevalence was 15.1% (95% CI 14.8%, 15.5%) using Charlson and 27.4% (27.0%, 27.8%) using Tonelli – agreement 85.1% (Kappa 0.57). Multimorbidity prevalence, using both measures, increased with age. Multimorbidity was higher in males (16.5%) than females (13.9%) using the Charlson measure, but similar across genders when measured with Tonelli. After adjusting for covariates, multimorbidity remained associated with longer length of stay (Charlson IRR 1.1 (1.0, 1.2); Tonelli IRR 1.1 (1.0, 1.2)) and readmission (Charlson OR 2.1 (1.9, 2.2); Tonelli OR 2.1 (2.0, 2.2)). Multimorbidity had a stronger association with mortality when measured using Charlson (OR 2.7 (2.5, 2.9)), than using Tonelli (OR (1.8 (1.7, 2.0)). ConclusionsMultimorbidity measures operationalised in hospital episode data identified those at risk of poor outcomes and such operationalised tools will be useful for future multimorbidity research and use in secondary care data systems. Multimorbidity measures are not interchangeable, and the choice of measure should depend on the purpose. Hightlights Operationalisation of two count-based multimorbidity measures using linked electronic hospitalepisode data was evaluated (Charlson and Tonelli). First study to compare the Tonelli measure with another measure for investigating multimor-bidity in hospitalised patients. Multimorbidity prevalence differed depending on measure used, but both multimorbidity mea-sures identified those at risk of poor outcomes. Operationalised multimorbidity tools have uses for future multimorbidity research and use insecondary care data systems. Multimorbidity measures are not interchangeable, and choice of measure should depend onpurpose.

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Section: Discussioncontrasting

confidence: 99%

Measuring multimorbidity in hospitalised patients using linked hospital episode data: comparison of two measures

Robertson

Ayansina

Johnston

et al. 2019

IJPDS

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“…Data were collected for consecutive patients aged ≥65 years who presented to the acute general surgical unit of each study site during May to June in 2013 and 2014. The data collection methods have been previously reported for each audit cycle . In brief, baseline demographics and comorbidities were recorded, and multimorbidity was defined as the presence of two or more comorbid conditions (Table S1), anemia was defined as hemoglobin <129 g/L, hypoalbuminemia as albumin <35 g/L, and polypharmacy as five or more medications on admission …”

Section: Methodsmentioning

confidence: 99%

“…The data collection methods have been previously reported for each audit cycle. [14][15][16] In brief, baseline demographics and comorbidities were recorded, and multimorbidity was defined as the presence of two or more comorbid conditions (Table S1), anemia was defined as hemoglobin <129 g/ L, hypoalbuminemia as albumin <35 g/L, and polypharmacy as five or more medications on admission. 17,18 Within 24 h of admission, and before any surgical intervention, participants received two cognitive function tests, the Confusion Assessment Method (CAM) and the Montreal Cognitive Assessment (MoCA).…”

Section: Methodsmentioning

confidence: 99%

Is anemia associated with cognitive impairment and delirium among older acute surgical patients?

Myint

Owen

McCarthy

et al. 2018

Geriatrics Gerontology Int

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AimThe determinants of cognitive impairment and delirium during acute illness are poorly understood, despite being common among older people. Anemia is common in older people, and there is ongoing debate regarding the association between anemia, cognitive impairment and delirium, primarily in non‐surgical patients.MethodsUsing data from the Older Persons Surgical Outcomes Collaboration 2013 and 2014 audit cycles, we examined the association between anemia and cognitive outcomes in patients aged ≥65 years admitted to five UK acute surgical units. On admission, the Confusion Assessment Method was carried out to detect delirium. Cognition was assessed using the Montreal Cognitive Assessment, and two levels of impairment were defined as Montreal Cognitive Assessment <26 and <20. Logistic regression models were constructed to examine these associations in all participants, and individuals aged ≥75 years only.ResultsA total of 653 patients, with a median age of 76.5 years (interquartile range 73.0–80.0 years) and 53% women, were included. Statistically significant associations were found between anemia and age; polypharmacy; hyperglycemia; and hypoalbuminemia. There was no association between anemia and cognitive impairment or delirium. The adjusted odds ratios of cognitive impairment were 0.95 (95% CI 0.56–1.61) and 1.00 (95% CI 0.61–1.64) for the Montreal Cognitive Assessment <26 and <20, respectively. The adjusted odds ratio of delirium was 1.00 (95% CI 0.48–2.10) in patients with anemia compared with those without. Similar results were observed for the ≥75 years age group.ConclusionsThere was no association between anemia and cognitive outcomes among older people in this acute surgical setting. Considering the retrospective nature of the study and possible lack of power, findings should be taken with caution. Geriatr Gerontol Int 2018; 18: 1025–1030.

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“…People aged ≥65 years accounted for 32% of emergency admissions and 39% of elective admissions requiring surgery across Australian hospitals . Multimorbidity, polypharmacy, frailty and geriatric syndromes are common in older surgical patients, who are at higher risk of postoperative complications and mortality . This raises the questions of whether and how geriatricians should contribute to the care of older surgical patients.…”

Section: Introductionmentioning

confidence: 99%

Geriatric medicine services for older surgical patients in acute hospitals: Results from a binational survey

Thillainadesan

Hilmer

et al. 2019

Australas J Ageing

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Objective To describe perioperative geriatric medicine services in Australia and New Zealand, and to explore geriatricians’ views on the need for and challenges in providing perioperative care. Method An electronic questionnaire was sent to heads of geriatric medicine departments. Results Sixty‐seven (83%) of 81 identified geriatric medicine departments responded. Twelve (18%) departments provide a proactive surgical‐geriatric medicine service. Their most common features were regular geriatric medicine ward rounds (100%), medication review (92%) and attendance at multidisciplinary meetings (83%). All respondents thought there was a need for geriatric medicine to provide greater input into the care of older surgical patients. Lack of funding (88%) and not enough geriatricians (58%) were the major perceived barriers. Conclusions Although geriatricians believe they should provide proactive collaborative care for older surgical patients, only a few hospitals currently provide these services. Funding streams for these services and further research to determine the best models of care are needed.

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

Cited by 71 publications

References 19 publications

Measuring multimorbidity in hospitalised patients using linked hospital episode data: comparison of two measures

Measuring multimorbidity in hospitalised patients using linked hospital episode data: comparison of two measures

Is anemia associated with cognitive impairment and delirium among older acute surgical patients?

Geriatric medicine services for older surgical patients in acute hospitals: Results from a binational survey

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