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Analyzing Impact of Multimorbidity on Long-Term Outcomes after Emergency General Surgery: A Retrospective Observational Cohort Study.
Rosen, Claire B; Roberts, Sanford E; Wirtalla, Chris J; Ramadan, Omar I; Keele, Luke J; Kaufman, Elinore J; Halpern, Scott D; Kelz, Rachel R.
Afiliación
  • Rosen CB; From the Department of Surgery (Rosen, Roberts, Ramadan, Kaufman, Kelz), Hospital of the University of Pennsylvania, Philadelphia, PA.
  • Roberts SE; The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA (Rosen, Roberts, Wirtalla, Keele, Kaufman, Halpern, Kelz).
  • Wirtalla CJ; From the Department of Surgery (Rosen, Roberts, Ramadan, Kaufman, Kelz), Hospital of the University of Pennsylvania, Philadelphia, PA.
  • Ramadan OI; The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA (Rosen, Roberts, Wirtalla, Keele, Kaufman, Halpern, Kelz).
  • Keele LJ; The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA (Rosen, Roberts, Wirtalla, Keele, Kaufman, Halpern, Kelz).
  • Kaufman EJ; From the Department of Surgery (Rosen, Roberts, Ramadan, Kaufman, Kelz), Hospital of the University of Pennsylvania, Philadelphia, PA.
  • Halpern SD; The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA (Rosen, Roberts, Wirtalla, Keele, Kaufman, Halpern, Kelz).
  • Kelz RR; From the Department of Surgery (Rosen, Roberts, Ramadan, Kaufman, Kelz), Hospital of the University of Pennsylvania, Philadelphia, PA.
J Am Coll Surg ; 235(5): 724-735, 2022 11 01.
Article en En | MEDLINE | ID: mdl-36250697
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.
Asunto(s)

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Contexto en salud: 11_ODS3_cobertura_universal Problema de salud: 11_delivery_arrangements / 11_governance_arrangements Asunto principal: Medicare / Multimorbilidad Tipo de estudio: Etiology_studies / Observational_studies / Risk_factors_studies Límite: Aged / Humans País/Región como asunto: America do norte Idioma: En Revista: J Am Coll Surg Asunto de la revista: GINECOLOGIA / OBSTETRICIA Año: 2022 Tipo del documento: Article País de afiliación: Panamá

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Contexto en salud: 11_ODS3_cobertura_universal Problema de salud: 11_delivery_arrangements / 11_governance_arrangements Asunto principal: Medicare / Multimorbilidad Tipo de estudio: Etiology_studies / Observational_studies / Risk_factors_studies Límite: Aged / Humans País/Región como asunto: America do norte Idioma: En Revista: J Am Coll Surg Asunto de la revista: GINECOLOGIA / OBSTETRICIA Año: 2022 Tipo del documento: Article País de afiliación: Panamá
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