Analyzing Impact of Multimorbidity on Long-Term Outcomes after Emergency General Surgery: A Retrospective Observational Cohort Study.
Analyzing Impact of Multimorbidity on Long-Term Outcomes after Emergency General Surgery: A Retrospective Observational Cohort Study.
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DOI：
10.1097/xcs.0000000000000303
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发表时间：
2022-11-01
影响因子：
5.2
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中科院分区：
文献类型：
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对于老年急诊普外科患者多病并存对长期预后的影响，我们知之甚少。使用医疗保险中心和医疗补助索赔数据确定了65岁及以上的联邦医疗保险受益人，他们接受了紧急普通手术条件的手术治疗。根据符合条件的合并症集(已知的与普通外科环境中住院死亡率增加相关的合并症的特定组合)将患者归类为多病患者，并与未合并多病患者进行比较。使用线性和Logistic回归计算出院后180天内的风险调整结果。在纳入的174,891名患者中，45.5%被确认为多病。多病患者在指数住院期间(5.9%比0.7%，OR3.05，p<；0.001)和出院后6个月(17.1%比3.4%，OR2.33，p<；0.001)死亡率较高。多发性疾病患者在出院后1个月(22.9%对11.4%，或1.48p<；0.001)和6个月(38.2%对21.2%，或1.48p<；0.001)的再住院率较高，较低的出院率(42.5%对74.2%，或0.52p&t；0.001)，较高的康复/护理机构出院率(28.3%对11.3%，或1.62p<；0.001)，比家庭氧气、助行器、轮椅、床边马桶和病床的使用量多一倍以上(p<；0.001)，更长的指数住院时间(增加1.33d住院天数，p<；0.001)，以及更高的六个月费用(额外5,162美元，p<；0.001)。在指数住院出院后的六个月内，年龄较大的多病患者在紧急普通手术后的结果比非多病患者更差，包括生存和独立功能。这些信息对于为高危患者设定康复预期以改善共同决策非常重要。这项全国性的回溯性观察研究发现，当存在合格的合并症集合时，多病患者在急诊普通手术后的6个月内遭受比非多病患者更差的结果(包括更高的死亡率和更低的独立性)。
Little is known about the impact of multimorbidity on long term outcomes for older emergency general surgery patients. Medicare beneficiaries, age 65 and older, who underwent operative management of an emergency general surgery condition were identified using Centers for Medicare and 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 to those without multimorbidity. Risk adjusted outcomes through 180 days after discharge from index hospitalization were calculated using linear and logistic regressions. 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%, OR 3.05, p<0.001), and through six months (17.1% vs 3.4%, OR 2.33, p<0.001) after discharge. Multimorbid patients suffered higher rates of readmission at one month (22.9% vs 11.4%, OR 1.48 p<0.001) and six 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 rehab/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 six months ($5,162 additional, p<0.001). Older, multimorbid patients suffer worse outcomes, including survival and independent function, after emergency general surgery than non-multimorbid patients through six months after discharge from index hospitalization. This information is important for setting recovery expectations for high-risk patients to improve shared decision making. This national retrospective observational study finds multimorbid patients, when defined by presence of a Qualifying Comorbidity Set, to suffer worse outcomes (including higher mortality and decreased independence) than non-multimorbid patients through 6 months after emergency general surgery.