title: Managing high-risk surgical patients: modifiable co-morbidities matter.
abstract: BACKGROUND
  There are a subset of potentially modifiable co-morbidities that may be targeted in the preoperative phase with a view to optimizing control and improving post-operative outcomes. This study aims to estimate the effect of potentially modifiable co-morbidities on post-operative outcomes and to identify potential targets for preoperative management.
  
  
  METHODS
  Retrospective data on hospital separations in South Australia were analyzed using multiple regression to estimate the association between nine potentially modifiable co-morbidities and length of stay, post-operative complications and in-hospital mortality.
  
  
  RESULTS
  After adjusting for primary diagnosis, age, gender and other potential confounders, significant increases in length of stay and complications were recorded for eight and six of the nine modifiable co-morbidities, respectively. As examples, previous heart failure was associated with a 54% increase in length of stay and an odds ratio of 1.75 for complications. Asthma and chronic obstructive pulmonary disease was associated with a 38% increase in length of stay and an odds ratio of 1.64 for complications.
  
  
  CONCLUSIONS
  A set of potentially modifiable co-morbidities is associated with a range of poorer post-operative outcomes, relative to patients without those co-morbidities. There is a clinical rationale that outcomes will be worse in the subset of patients for whom such co-morbidities are poorly controlled, and that timely intervention to improve control in the period prior to surgery will improve post-operative outcomes. Further research is required on post-operative outcomes for patients with and without controlled co-morbidities and on the effects of timely intervention to improve control prior to surgery.
authors.affiliation: Discipline of Public Health, The University of Adelaide, Adelaide, South Australia, Australia.
authors.forename: Clarabelle
authors.initials: C
authors.lastname: Pham
authors.forename: Catherine
authors.initials: C
authors.lastname: Gibb
authors.forename: John
authors.initials: J
authors.lastname: Field
authors.forename: Jodi
authors.initials: J
authors.lastname: Gray
authors.forename: Robert
authors.initials: R
authors.lastname: Fitridge
authors.forename: Villis
authors.initials: V
authors.lastname: Marshall
authors.forename: Jonathan
authors.initials: J
authors.lastname: Karnon
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000209:etiology* / Q000401:mortality / Q000517:prevention & control; D011300:Preoperative Care; D057234:Preoperative Period; D012189:Retrospective Studies; D012306:Risk; D018570:Risk Assessment; D012307:Risk Factors
keywords: co-morbidity; optimization; outcome; preoperative care