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Defining Multimorbidity in Older Surgical Patients

Jeffrey H Silber1,2,3,4,5, Joseph G Reiter1, Paul R Rosenbaum5,6

  • 1Center for Outcomes Research, Children's Hospital of Philadelphia.

Medical Care
|July 12, 2018
PubMed
Abstract

Insights

A new study identified 576 specific comorbidity combinations (QCSs) that significantly increase mortality risk in older surgical patients. This research helps pinpoint vulnerable individuals with multimorbidity (MM) for better care.

Area of Science:

  • Gerontology
  • Surgical Outcomes
  • Epidemiology

Background:

  • Multimorbidity (MM) lacks a standardized definition, hindering systematic analysis of comorbidity interactions.
  • Existing research often overlooks specific comorbidity combinations and multiple testing issues in large datasets.

Purpose of the Study:

  • To develop and validate a comprehensive list of single, double, and triple comorbidity combinations (QCSs).
  • To identify QCSs that more than double the odds of mortality.
  • To define patients with at least one QCS as having multimorbidity (MM).

Main Methods:

  • A cohort-based study was conducted using fee-for-service Medicare patients aged 65-85 undergoing general surgery.
  • A matching validation study was employed.
  • Data from 2009-2010 and 2011-2013 were analyzed, focusing on 30-day mortality.

Main Results:

  • 576 Qualifying Comorbidity Sets (QCSs) were identified, each more than doubling mortality odds.
  • In 2011, 36% of eligible patients had MM.
  • Multimorbid patients exhibited a 7.0% mortality rate, significantly higher than non-multimorbid patients (1.6%).
  • Patients with MM had an odds ratio of 1.90 compared to a mixed reference group and 3.72 compared to non-multimorbid patients.
  • A significant difference in mortality rates (6.7% vs. 5.2%) was observed between low- and high-volume hospitals for matched MM patients.

Conclusions:

  • A defined list of QCSs identified a substantial proportion of older surgical patients with significantly elevated mortality risk.
  • These QCSs can serve as a tool to identify vulnerable patients.
  • Understanding specific comorbidity combinations is crucial for predicting poor outcomes and tailoring interventions.

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