Heath status, frailty, and multimorbidity in patients with emergency general surgery conditions

Abstract

Background: Although nearly 1 million older adults are admitted for emergency general surgery conditions yearly, the extent to which baseline health influences the development and treatment of emergency general surgery conditions is unknown. We evaluated baseline health and older patients with and without emergency general surgery conditions.

Methods: We used the prospectively collected Medicare Current Beneficiary Survey with Medicare claims and 2 validated health frameworks: (1) Deficit Accumulation Frailty Score and (2) Complex Multimorbidity. Self-reported health and function items were used to derive pre-emergency general surgery conditions Deficit Accumulation Frailty Score and Complex Multimorbidity scores. Deficit Accumulation Frailty Score ranges from 0 (no frailty deficits) to 100 (all possible deficits present). Complex Multimorbidity is a 3-point categorical rank based on the presence of chronic conditions, functional limitations, and geriatric syndromes. Specific survey factors were also examined to determine association with development of emergency general surgery conditions or use of operative management.

Results: Of 54,417 individuals, 1,960 had emergency general surgery conditions (median age 79 [interquartile range 73-84]). Patients with emergency general surgery conditions had significantly higher Deficit Accumulation Frailty Score (19 [interquartile range 11-31] vs 14 [8-24]) and were more likely to be in the most severe Complex Multimorbidity category (38% vs 29%). Emergency general surgery conditions patients had higher proportions of nearly every health category, with the most striking differences in functional limitations. Patients who were treated nonoperatively had the poorest overall baseline health.

Conclusion: Patients who developed emergency general surgery conditions had more severe health burden than patients who did not, particularly in functional status. Clinicians must better understand the interaction between baseline health vulnerability and emergency surgical disease to improve prognostication and ensure alignment of patient goals and treatment strategies.

Figure 1.. Patient Selection

Flowchart of study design with inclusion/exclusion criteria. EGSc: Emergency General Surgery conditions; EGS-Nonop: EGSc patients who did not undergo surgery; EGS-Op: EGSc patients who did undergo surgery. RIC2: health and functional status survey.

Figure 2.. Component Factors and Standardized Differences, Functional Limitations

This figure displays the standardized differences of the functional limitation components of the deficit accumulation frailty score and the multimorbidity framework. ○ represents the standardized difference calculated as (Proportion of EGSc)-(Proportion of No EGSc); location of ○ further to the right indicates a larger difference in proportions, with that item being more common in the EGSc group. Similarly, + represents the standardized difference calculated as (Proportion of EGS-Nonop)-(Proportion of EGS-Op); location of + further to the right indicates a larger difference in proportions, with that item being more common in the EGS-Nonop group.

Figure 3.. Component Factors and Standardized Differences: Geriatric Syndromes and Chronic Conditions

This figure displays the standardized differences of the geriatric syndromes and chronic conditions components of the deficit accumulation frailty score and the multimorbidity framework. ○ represents the standardized difference calculated as (Proportion of EGSc)-(Proportion of No EGSc); location of ○ further to the right indicates a larger difference in proportions, with that item being more common in the EGSc group. Similarly, + represents the standardized difference calculated as (Proportion of EGS-Nonop)-(Proportion of EGS-Op); location of + further to the right indicates a larger difference in proportions, with that item being more common in the EGS-Nonop group.