title: Prevalence of multimorbidity and its association with outcomes in older emergency general surgical patients: an observational study.
abstract: OBJECTIVE
  Multimorbidity is the presence of 2 or more medical conditions. This increasingly used assessment has not been assessed in a surgical population. The objectives of this study were to assess the prevalence of multimorbidity and its association with common outcome measures.
  
  
  METHODS
  A cross-sectional observational study.
  
  
  METHODS
  A UK-based multicentre study, included participants between July and October 2014.
  
  
  METHODS
  Consecutive emergency (non-elective) general surgical patients admitted to hospital, aged over 65 years.
  
  
  METHODS
  The outcome measures were (1) the prevalence of multimorbidity and (2) the association between multimorbidity and frailty; the rate and severity of surgery; length of hospital stay; readmission to hospital within 30 days of discharge; and death at 30 and 90 days.
  
  
  RESULTS
  Data were collected on 413 participants aged 65-98 years (median 77 years, (IQR (70-84)). 51.6% (212/413) participants were women. Multimorbidity was present in 74% (95% CI 69.7% to 78.2%) of the population and increased with age (p<0.0001). Multimorbidity was associated with increasing frailty (p for trend <0.0001). People with multimorbidity underwent surgery as often as those without multimorbidity, including major surgery (p=0.03). When comparing multimorbid people with those without multimorbidity, we found no association between length of hospital stay (median 5 days, IQR (1-54), vs 6 days (1-47), (p=0.66)), readmission to hospital (64 (21.1%) vs 18 (16.8%) (p=0.35)), death at 30 days (14 (4.6%) vs 6 (5.6%) (p=0.68)) or 90-day mortality (28 (9.2%) vs 8 (7.6%) (p=0.60)).
  
  
  CONCLUSIONS
  Multimorbidity is common. Nearly three-quarters of this older emergency general surgical population had 2 or more chronic medical conditions. It was strongly associated with age and frailty, and was not a barrier to surgical intervention. Multimorbidity showed no associations across a range of outcome measures, as it is currently defined. Multimorbidity should not be relied on as a useful clinical tool in guidelines or policies for older emergency surgical patients.
authors.affiliation: Division of Population Medicine, Cardiff University, Cardiff, UK.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Hewitt
authors.affiliation: Department of Medicine for the Elderly, Aberdeen Royal Infirmary, Aberdeen, UK.
authors.forename: Caroline
authors.initials: C
authors.lastname: McCormack
authors.affiliation: Department of Medicine for the Elderly, Aberdeen Royal Infirmary, Aberdeen, UK.
authors.forename: Hui Sian
authors.initials: HS
authors.lastname: Tay
authors.affiliation: Department of Medicine for the Elderly, Aberdeen Royal Infirmary, Aberdeen, UK.
authors.forename: Matthew
authors.initials: M
authors.lastname: Greig
authors.affiliation: Department of General Surgery, Manchester Royal Infirmary, Manchester, UK.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Law
authors.affiliation: Department of General Surgery, Royal Alexandra Hospital, Paisley, Greater Glasgow, UK.
authors.forename: Adam
authors.initials: A
authors.lastname: Tay
authors.affiliation: Department of General Surgery, Royal Alexandra Hospital, Paisley, Greater Glasgow, UK.
authors.forename: Nurwasimah Hj
authors.initials: NH
authors.lastname: Asnan
authors.affiliation: Division of Population Medicine, Cardiff University, Cardiff, UK.
authors.forename: Ben
authors.initials: B
authors.lastname: Carter
authors.affiliation: Department of Medicine for the Elderly, Aberdeen Royal Infirmary, Aberdeen, UK Epidemiology Group, Institute of Applied Health Sciences, School of Medicine and Dentistry, University of Aberdeen, Aberdeen, UK.
authors.forename: Phyo Kyaw
authors.identifier: http://orcid.org/0000-0003-3852-6158
authors.initials: PK
authors.lastname: Myint
authors.affiliation: Department of General Surgery, Manchester Royal Infirmary, Manchester, UK.
authors.forename: Lyndsay
authors.initials: L
authors.lastname: Pearce
authors.affiliation: Department of General Surgery, Royal Alexandra Hospital, Paisley, Greater Glasgow, UK.
authors.forename: Susan J
authors.initials: SJ
authors.lastname: Moug
authors.affiliation: Department of General Surgery, North Bristol NHS Trust, Bristol, UK.
authors.forename: Kathryn
authors.initials: K
authors.lastname: McCarthy
authors.affiliation: Department of General Surgery, University Hospital of Wales, Cardiff, UK.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Stechman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease / Q000401:mortality*; D015897:Comorbidity; D003430:Cross-Sectional Studies; D004632:Emergency Medical Services; D005260:Female; D016330:Frail Elderly; D015577:Geriatric Assessment; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D017063:Outcome Assessment, Health Care; D015995:Prevalence; D012307:Risk Factors; D013514:Surgical Procedures, Operative / Q000401:mortality*; D006113:United Kingdom / Q000453:epidemiology
keywords: EPIDEMIOLOGY; GERIATRIC MEDICINE; Multimorbidity; SURGERY