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Redefining Multimorbidity in Older Surgical Patients.

Omar I Ramadan1,2, Paul R Rosenbaum2,3, Joseph G Reiter4

  • 1From the Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA (Ramadan, Kelz).

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Summary

New surgical multimorbidity definitions identify specific, high-risk patients, improving clinical decision-making. These specialty-specific criteria better predict mortality than conventional methods.

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Area of Science:

  • Geriatric Surgery
  • Health Services Research
  • Clinical Epidemiology

Background:

  • Multimorbidity is common in surgical patients, negatively impacting outcomes.
  • Conventional definitions (≥2 comorbidities) over-identify older patients, reducing clinical utility.
  • Need for specialty-specific multimorbidity definitions based on distinct comorbidity combinations.

Purpose of the Study:

  • Develop and validate novel, specialty-specific multimorbidity definitions for surgical patients.
  • Identify comorbidity combinations significantly associated with increased 30-day mortality.
  • Assess the impact of hospital resources on outcomes for multimorbid patients.

Main Methods:

  • Utilized Medicare claims data for patients aged 66-90 undergoing general, orthopaedic, or vascular surgery.
  • Identified "qualifying comorbidity sets" linked to ≥1.5-fold increased 30-day mortality risk.
  • Validated definitions using 2018-2019 data and analyzed differential outcomes by hospital resource levels.

Main Results:

  • New definitions identified fewer multimorbid patients compared to conventional ones across all surgical types (e.g., vascular: 52.7% vs 96.2%).
  • Higher 30-day mortality rates were observed with new definitions (e.g., vascular: 7.00% vs 4.43%).
  • Better-resourced hospitals showed greater mortality benefits for multimorbid patients in general and orthopaedic surgery.

Conclusions:

  • Novel multimorbidity definitions offer greater specificity and identify higher-risk patient pools.
  • These refined definitions can enhance clinical decision-making in surgical care.
  • Further research may explore tailored interventions based on these specific multimorbidity profiles.