Association between multimorbidity and postoperative mortality in patients undergoing major surgery: a prospective study in 29 countries across Europe
- Authors: Writing group: Kamarajah SK, Kouli O, Ahuja S, Blackwell S, Dhesi J, Docherty A, El-Boghdadly K, Glasbey JC, McLean KA, Moonesinghe SR, Morton B, Moug S, Nirantharakumar K, Pinkney T, Spencer S, Yeung J, Harrison EM, Bhangu AA, Morton DG Data analysis: Kamarajah SK, Kouli O, Knight SR, Harrison EM (overall guarantor) Steering Committee: Blanco-Colino R, Brindl N, Brown S, Cambridge WA, Chaudhry D, Gressmann K, Gujjuri RR, Hilder A, Jaffer A, Jakaityte I, Kamarajah SK, Kawka M, Kouli O, Matey E, McLean KA, Mergo A, Mills EC, Murray V, Ooi SZY, Pereira IS, Riad AM, Sgrò A, Shafi SQ, Trout I, Turňa A, Varghese C, Xu W External advisory group: Biccard BM, Docherty A, Martin J, El-Boghdadly K, Phull M, Mouton R, Bhangu A, Glasbey JC, Harrison EM, McLean KA, Smart N, Moug S, Pinkney T, Richards T National leads: Dajti I (Albania), de Cillia M (Austria), Van Ramshorst G (Belgium), Delibegovic S (Bosnia and Herzegovina), Mughal H (Bulgaria), Mihanovic J (Croatia), Gouvas N (Cyprus), Kocian P (Czech Republic), Levesen V (Denmark), Kaupilla J (Finland), Brindl N (Germany), Merz D (Germany), Joos M (Germany), Ioannidis A (Greece), Nnaji G (Hungary), Pata F (Italy), Pellino G (Italy), Fekaj E (Kosovo), Oliver Senica S (Latvia), Dauksa A (Lithuania), Psaila J (Malta), de Ruitjer F (Netherlands), Major P (Poland), Santos I (Portugal), Sampaio Alves M (Portugal), Simões J (Portugal), Bonci EA (Romania), Pașca A (Romania), Novikova A (Russia), Kovačević B (Serbia), Milosavljevic V (Serbia), Tadic B (Serbia), Kosir J (Slovenia), Blanco-Colino R (Spain), Pérez Ajates S (Spain), Ossola Revilla ME (Spain), Papadia A (Switzerland), Riboni C (Switzerland), Gasparri ML (Switzerland), Aktas MK (Turkey), Baki BE (Turkey), Tepe MD (Turkey), Mutlu AU (Turkey), Regional leads United Kingdom: Singal A (Aston University Medical School); Osei-Bonsu J (Barts and The London School of Medicine and Dentistry); Lacey H (Brighton and Sussex Medical School); Chan SW (Cardiff University School of Medicine); Allison M (Hull York Medical School); Duah-Asante K (Imperial College London Faculty of Medicine); Chen D (Keele University School of Medicine); Ahmed N (King’s College London GKT School of Medical Education); Ejiz A (Lancaster University Medical School); Takyi C (Newcastle University School of Medical Education); Mujeeb M (Plymouth University Peninsula Schools of Medicine and Dentistry); Ravikumar N (Queen’s University Belfast School of Medicine); Khan M (Royal College of Surgeons in Ireland School of Medicine); Hayes J (St George’s, University of London); Mckenna J (Swansea University Medical School); Wang J (The University of Edinburgh Medical School); Essa N (Trinity College Dublin School of Medicine); Xianghan H (University College Cork School of Medicine); Ko L (University College Dublin School of Medicine); Aldabbagh Y (University College London Medical School); Plascevic J (University of Aberdeen School of Medicine and Dentistry); Zia N (University of Birmingham College of Medical and Dental Sciences); Ismail R (University of Bristol Medical School); Kamel Y (University of Buckingham Medical School); Epanomeritakis I (University of Cambridge School of Clinical Medicine); Tan R (University of Dundee School of Medicine); Chiu N (University of Exeter Medical School); Naeem A (University of Glasgow School of Medicine); Kakwani M (University of Leeds School of Medicine); Mehra R (University of Leicester Medical School); Feeney K (University of Limerick School of Medicine); Yan Naing CL (University of Liverpool School of Medicine); Qureshi A (University of Manchester Medical School); Richens A (University of Nottingham School of Medicine); Li H (University of Oxford Medical Sciences Division); Ahmed R (University of Sheffield Medical School); Wilson L (University of Southampton School of Medicine); Abraha S (University of Warwick Medical School). Italy: Gori A, Moggia E, Podda M, Riboni C
- Publication year: 2024
- Type: Articolo in rivista
- OA Link: http://hdl.handle.net/10447/642056
Abstract
Background Multimorbidity poses a global challenge to healthcare delivery. This study aimed to describe the prevalence of multimorbidity, common disease combinations and outcomes in a contemporary cohort of patients undergoing major abdominal surgery. Methods This was a pre-planned analysis of a prospective, multicentre, international study investigating cardiovascular complications after major abdominal surgery conducted in 446 hospitals in 29 countries across Europe. The primary outcome was 30-day postoperative mortality. The secondary outcome measure was the incidence of complications within 30 days of surgery. Results Of 24,227 patients, 7006 (28.9%) had one long-term condition and 10,486 (43.9%) had multimorbidity (two or more long-term health conditions). The most common conditions were primary cancer (39.6%); hypertension (37.9%); chronic kidney disease (17.4%); and diabetes (15.4%). Patients with multimorbidity had a higher incidence of frailty compared with patients ≤ 1 long-term health condition. Mortality was higher in patients with one long-term health condition (adjusted odds ratio 1.93 (95%CI 1.16–3.23)) and multimorbidity (adjusted odds ratio 2.22 (95%CI 1.35–3.64)). Frailty and ASA physical status 3–5 mediated an estimated 31.7% of the 30-day mortality in patients with one long-term health condition (adjusted odds ratio 1.30 (95%CI 1.12– 1.51)) and an estimated 36.9% of the 30-day mortality in patients with multimorbidity (adjusted odds ratio 1.61 (95%CI 1.36–1.91)). There was no improvement in 30-day mortality in patients with multimorbidity who received pre-operative medical assessment. Conclusions Multimorbidity is common and outcomes are poor among surgical patients across Europe. Addressing multimorbidity in elective and emergency patients requires innovative strategies to account for frailty and disease control. The development of such strategies, that integrate care targeting whole surgical pathways to strengthen current systems, is urgently needed for multimorbid patients. Interventional trials are warranted to determine the effectiveness of targeted management for surgical patients with multimorbidity.