Background Multimorbidity poses a global challenge to healthcare delivery. This study aimed to describe theprevalence of multimorbidity, common disease combinations and outcomes in a contemporary cohort ofpatients undergoing major abdominal surgery.Methods This was a pre-planned analysis of a prospective, multicentre, international study investigatingcardiovascular complications after major abdominal surgery conducted in 446 hospitals in 29 countries acrossEurope. The primary outcome was 30-day postoperative mortality. The secondary outcome measure was theincidence of complications within 30 days of surgery.Results Of 24,227 patients, 7006 (28.9%) had one long-term condition and 10,486 (43.9%) had multimorbidity(two or more long-term health conditions). The most common conditions were primary cancer (39.6%);hypertension (37.9%); chronic kidney disease (17.4%); and diabetes (15.4%). Patients with multimorbidity had ahigher incidence of frailty compared with patients ≤ 1 long-term health condition. Mortality was higher inpatients with one long-term health condition (adjusted odds ratio 1.93 (95%CI 1.16–3.23)) and multimorbidity(adjusted odds ratio 2.22 (95%CI 1.35–3.64)). Frailty and ASA physical status 3–5 mediated an estimated 31.7%of the 30-day mortality in patients with one long-term health condition (adjusted odds ratio 1.30 (95%CI 1.12–1.51)) and an estimated 36.9% of the 30-day mortality in patients with multimorbidity (adjusted odds ratio 1.61(95%CI 1.36–1.91)). There was no improvement in 30-day mortality in patients with multimorbidity who receivedpre-operative medical assessment.Conclusions Multimorbidity is common and outcomes are poor among surgical patients across Europe.Addressing multimorbidity in elective and emergency patients requires innovative strategies to account forfrailty and disease control. The development of such strategies, that integrate care targeting whole surgicalpathways to strengthen current systems, is urgently needed for multimorbid patients. Interventional trials arewarranted to determine the effectiveness of targeted management for surgical patients with multimorbidity

Association between multimorbidity and postoperative mortality in patients undergoing major surgery: a prospective study in 29 countries across Europe / Kamarajah, S.K., Kouli, O., Ahuja, S., Blackwell, S., Dhesi, J., Docherty, A., El-Boghdadly, K., Glasbey, J.C., Mclean, K.A., Moonesinghe, S.R., Morton, B., Moug, S., Nirantharakumar, K., Pinkney, T., Spencer, S., Yeung, J., Harrison, E.M., Bhangu, A.A., Morton, D.G., Knight, S.R., et al.. - In: ANAESTHESIA. - ISSN 0003-2409. - 79:9(2024), pp. 945-956. [10.1111/anae.16324]

Association between multimorbidity and postoperative mortality in patients undergoing major surgery: a prospective study in 29 countries across Europe

Porcu A.;Perra T.;Scognamillo F.;Scanu A. M.;Feo C.;Cossu M. L.;
2024-01-01

Abstract

Background Multimorbidity poses a global challenge to healthcare delivery. This study aimed to describe theprevalence of multimorbidity, common disease combinations and outcomes in a contemporary cohort ofpatients undergoing major abdominal surgery.Methods This was a pre-planned analysis of a prospective, multicentre, international study investigatingcardiovascular complications after major abdominal surgery conducted in 446 hospitals in 29 countries acrossEurope. The primary outcome was 30-day postoperative mortality. The secondary outcome measure was theincidence of complications within 30 days of surgery.Results Of 24,227 patients, 7006 (28.9%) had one long-term condition and 10,486 (43.9%) had multimorbidity(two or more long-term health conditions). The most common conditions were primary cancer (39.6%);hypertension (37.9%); chronic kidney disease (17.4%); and diabetes (15.4%). Patients with multimorbidity had ahigher incidence of frailty compared with patients ≤ 1 long-term health condition. Mortality was higher inpatients with one long-term health condition (adjusted odds ratio 1.93 (95%CI 1.16–3.23)) and multimorbidity(adjusted odds ratio 2.22 (95%CI 1.35–3.64)). Frailty and ASA physical status 3–5 mediated an estimated 31.7%of the 30-day mortality in patients with one long-term health condition (adjusted odds ratio 1.30 (95%CI 1.12–1.51)) and an estimated 36.9% of the 30-day mortality in patients with multimorbidity (adjusted odds ratio 1.61(95%CI 1.36–1.91)). There was no improvement in 30-day mortality in patients with multimorbidity who receivedpre-operative medical assessment.Conclusions Multimorbidity is common and outcomes are poor among surgical patients across Europe.Addressing multimorbidity in elective and emergency patients requires innovative strategies to account forfrailty and disease control. The development of such strategies, that integrate care targeting whole surgicalpathways to strengthen current systems, is urgently needed for multimorbid patients. Interventional trials arewarranted to determine the effectiveness of targeted management for surgical patients with multimorbidity
2024
Association between multimorbidity and postoperative mortality in patients undergoing major surgery: a prospective study in 29 countries across Europe / Kamarajah, S.K., Kouli, O., Ahuja, S., Blackwell, S., Dhesi, J., Docherty, A., El-Boghdadly, K., Glasbey, J.C., Mclean, K.A., Moonesinghe, S.R., Morton, B., Moug, S., Nirantharakumar, K., Pinkney, T., Spencer, S., Yeung, J., Harrison, E.M., Bhangu, A.A., Morton, D.G., Knight, S.R., et al.. - In: ANAESTHESIA. - ISSN 0003-2409. - 79:9(2024), pp. 945-956. [10.1111/anae.16324]
File in questo prodotto:
File Dimensione Formato  
2024-Association-between-multimorbidity-.pdf

accesso aperto

Tipologia: Versione editoriale (versione finale pubblicata)
Licenza: Creative commons
Dimensione 1.11 MB
Formato Adobe PDF
1.11 MB Adobe PDF Visualizza/Apri

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11388/339269
Citazioni
  • ???jsp.display-item.citation.pmc??? ND
  • Scopus 31
  • ???jsp.display-item.citation.isi??? 33
social impact