Analyzing the Impact of Multimorbidity on Long-Term Outcomes after Emergency General Surgery

Abstract

INTRODUCTION: Many older patients with multiple comorbidities require emergency general surgery (EGS). Little is known about the impact of specific combinations of comorbidities (ie multimorbidity) on long-term outcomes for older EGS patients. METHODS: Medicare beneficiaries age 65 and older who presented to an acute care hospital and underwent EGS were identified using Medicare claims data (100% sample, 2015 to -2018). Patients were classified as multimorbid based on the presence of a Qualifying Comorbidity Set (a specific combination of comorbid conditions associated with increased risk of in-hospital mortality after general surgery) and compared with those without multimorbidity. Risk-adjusted outcomes through 180 days after discharge from index hospitalization were calculated using mixed-effects linear and logistic regression. RESULTS: Of 174,891 patients, 48.4% were identified as multimorbid. Multimorbid patients had higher rate of mortality and readmission through 180 days and higher rate of discharge to a rehabilitation/nursing facility or hospice (see Table). Compared with nonmultimorbid patients, multimorbid patients experienced longer index hospitalization (1.4 additional days, p < 0.001), higher cost through 180 days ($5,324 additional, p < 0.001), and greater than double the use of home oxygen (3.6% vs 1%, p < 0.001), walker (11.4% vs 4.2%, p < 0.001), wheelchair (1.9% vs 0.3%, p < 0.001), bedside commode (3.6% vs 1.1%, p < 0.001), and hospital bed (1.2% vs 0.2%, p < 0.001). Table. - Unadjusted and Adjusted Outcomes for Multimorbid and Nonmultimorbid Patients Outcomes metric Unadjusted proportion of multimorbid patients Unadjusted proportion of nonmultimorbid patients Adjusted odds ratio comparing multimorbid with nonmultimorbid patients p Value Died in hospital 5.8% 0.5% 3.75 <0.001 Died within 30 d 9.2% 1.2% 3.09 <0.001 Died within 90 d 13.5% 2.1% 2.7 <0.001 Died within 180 d 16.7% 3.1% 2.48 <0.001 Readmitted within 30 d 21.7% 10.9% 1.54 <0.001 Readmitted within 90 d 35.1% 13.2% 1.52 <0.001 Readmitted within 180 d 33.3% 15.3% 1.5 <0.001 Discharged to rehabilitation or nursing facility 29.7% 10.7% 1.72 <0.001 Discharged to hospice 2.2% 0.3% 2.6 <0.001 CONCLUSION: Among older patients, multimorbid patients experience worse outcomes after EGS than nonmultimorbid patients. Beyond survival, multimorbid patients experience greater loss of independence. This information is important for setting recovery expectations for high-risk patients to improve shared decision making.