Department of Surgery, MetroHealth Medical Center, Cleveland, OH; Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH.
Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH. Electronic address: https://twitter.com/Wyatt_Bensken.
Surgery. 2022 Jul;172(1):446-452. doi: 10.1016/j.surg.2022.02.011. Epub 2022 Apr 6.
Although nearly 1 million older adults are admitted for emergency general surgery conditions yearly, the extent to which baseline health influences the development and treatment of emergency general surgery conditions is unknown. We evaluated baseline health and older patients with and without emergency general surgery conditions.
We used the prospectively collected Medicare Current Beneficiary Survey with Medicare claims and 2 validated health frameworks: (1) Deficit Accumulation Frailty Score and (2) Complex Multimorbidity. Self-reported health and function items were used to derive pre-emergency general surgery conditions Deficit Accumulation Frailty Score and Complex Multimorbidity scores. Deficit Accumulation Frailty Score ranges from 0 (no frailty deficits) to 100 (all possible deficits present). Complex Multimorbidity is a 3-point categorical rank based on the presence of chronic conditions, functional limitations, and geriatric syndromes. Specific survey factors were also examined to determine association with development of emergency general surgery conditions or use of operative management.
Of 54,417 individuals, 1,960 had emergency general surgery conditions (median age 79 [interquartile range 73-84]). Patients with emergency general surgery conditions had significantly higher Deficit Accumulation Frailty Score (19 [interquartile range 11-31] vs 14 [8-24]) and were more likely to be in the most severe Complex Multimorbidity category (38% vs 29%). Emergency general surgery conditions patients had higher proportions of nearly every health category, with the most striking differences in functional limitations. Patients who were treated nonoperatively had the poorest overall baseline health.
Patients who developed emergency general surgery conditions had more severe health burden than patients who did not, particularly in functional status. Clinicians must better understand the interaction between baseline health vulnerability and emergency surgical disease to improve prognostication and ensure alignment of patient goals and treatment strategies.
尽管每年有近 100 万老年人因急诊普通外科疾病入院，但基础健康对急诊普通外科疾病的发展和治疗的影响程度尚不清楚。我们评估了基础健康状况以及患有和不患有急诊普通外科疾病的老年患者。
我们使用了前瞻性收集的 Medicare 现行受益人调查（与 Medicare 索赔和 2 个经过验证的健康框架相结合）：（1）缺陷积累衰弱评分和（2）复杂多病共存。自我报告的健康和功能项目用于推导出急诊普通外科疾病发生前的缺陷积累衰弱评分和复杂多病共存评分。缺陷积累衰弱评分范围从 0（无衰弱缺陷）到 100（存在所有可能的缺陷）。复杂多病共存是基于慢性疾病、功能障碍和老年综合征存在情况的 3 分类别等级。还检查了特定的调查因素，以确定与急诊普通外科疾病的发展或手术管理的使用相关的因素。
在 54417 人中，有 1960 人患有急诊普通外科疾病（中位年龄 79 [四分位距 73-84]）。患有急诊普通外科疾病的患者缺陷积累衰弱评分明显更高（19 [四分位距 11-31] 比 14 [8-24]），且更有可能处于最严重的复杂多病共存类别（38% 比 29%）。急诊普通外科疾病患者几乎所有健康类别的比例都较高，其中功能障碍的差异最为显著。未接受非手术治疗的患者总体基础健康状况最差。
与未患有急诊普通外科疾病的患者相比，患有急诊普通外科疾病的患者健康负担更重，尤其是在功能状态方面。临床医生必须更好地理解基础健康脆弱性与急诊外科疾病之间的相互作用，以改善预后，并确保患者目标和治疗策略的一致性。
