Key Takeaways
- New definitions surpass conventional definitions: The new study developed and validated better surgical, specialty-specific, multimorbidity definitions based on distinct characteristics of older inpatient general, orthopedic, and vascular surgery patients.
- Mortality risk is higher for some patients: For some types of surgery, patients with certain combinations of comorbidities face significantly higher 30-day mortality risk than patients who are lower risk.
- Helping assess overall risk: Researchers anticipate that the new multimorbidity definitions will help surgeons better explain the risks associated with any given procedure to patients and to make better care decisions.
CHICAGO (March 15, 2023): A new way to identify more specific, higher-risk groups of older surgical patients can help in clinical decision-making and accurately comparing the performance of one hospital to another, according to research published in the Journal of the American College of Surgeons.
Multimorbidity in surgical patients is defined as multiple comorbidities or chronic conditions that are common and associated with worse postoperative outcomes. Conventional multimorbidity definitions offer limited clinical usefulness because they label the vast majority of older patients as "multimorbid," do not specify which comorbidities are contributing to the risk, and do not incorporate the patient's functional status.
The new study developed and validated better surgical, specialty-specific, multimorbidity definitions based on distinct comorbidity combinations for older inpatient general, orthopedic, and vascular surgery patients. The new definitions were able to specify high-risk comorbidity combinations that contribute to patient risk while also addressing patients' functional status, said the study's lead author Omar I. Ramadan, MD, MSc, a general surgery resident at the University of Pennsylvania Perelman School of Medicine in Philadelphia.
"Ultimately, our multimorbidity methodology is a powerful way to assess risk and it's easy to apply because it uses administrative datasets," Dr. Ramadan said.
Multimorbidity definitions
Using Medicare administrative claims data, the researchers analyzed patients aged 66-90 years undergoing either inpatient general, orthopedic, or vascular surgery procedures between 2016 and 2017 to develop the multimorbidity definitions. The researchers then analyzed patients between 2018 and 2019 to validate the definitions. These patients were categorized into clinically relevant groups by ICD-10 principal procedure codes. In the development of the definitions for multimorbidity, the researchers did not include patients with metastatic cancer, Alzheimer's disease and related dementias, or who were 90 years or older. These conditions are already associated with high mortality rates and patients with them would possibly have different goals of care if faced with severe postoperative complications. However, patients with these characteristics were studied using their new multimorbidity definitions.
