From the Department of Surgery (Rosen, Roberts, Ramadan, Kaufman, Kelz), Hospital of the University of Pennsylvania, Philadelphia, PA.
The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA (Rosen, Roberts, Wirtalla, Keele, Kaufman, Halpern, Kelz).
J Am Coll Surg. 2022 Nov 1;235(5):724-735. doi: 10.1097/XCS.0000000000000303. Epub 2022 Oct 17.
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 & 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.
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).
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.
对于老年急诊普外科患者，合并多种疾病对其长期预后的影响知之甚少。
利用医疗保险和医疗补助服务中心（Centers for Medicare & Medicaid Services）的理赔数据，确定了年龄在 65 岁及以上、接受急诊普外科手术治疗的医疗保险受益人的资料。根据是否存在符合特定条件的合并症组合（在普外科手术环境中与住院死亡率增加相关的一组特定合并症）来判断患者是否合并多种疾病，并与无合并多种疾病的患者进行比较。使用线性和逻辑回归计算出院后 180 天内风险调整后的结局。
在纳入的 174891 名患者中，45.5%的患者被诊断为合并多种疾病。合并多种疾病的患者在住院期间（5.9% vs 0.7%，比值比[OR]3.05，p < 0.001）和出院后 6 个月（17.1% vs 3.4%，OR 2.33，p < 0.001）的死亡率更高。合并多种疾病的患者在出院后 1 个月（22.9% vs 11.4%，OR 1.48，p < 0.001）和 6 个月（38.2% vs 21.2%，OR 1.48，p < 0.001）的再入院率更高，出院回家的比例更低（42.5% vs 74.2%，OR 0.52，p < 0.001），出院至康复/护理院的比例更高（28.3% vs 11.3%，OR 1.62，p < 0.001），家庭氧疗、助行器、轮椅、床边便椅和病床的使用率高出两倍以上（p < 0.001），住院时间延长 1.33 天（p < 0.001），出院后 6 个月的费用增加 5162 美元（p < 0.001）。
与非合并多种疾病的患者相比，年龄较大、合并多种疾病的老年急诊普外科患者在出院后 6 个月内的生存和独立功能等结局更差。这一信息对于设定高危患者的康复预期，以改善共同决策非常重要。
