Association between multimorbidity and postoperative mortality in patients undergoing major surgery: a prospective study in 29 countries across Europe

Starsurg Collaborative; EuroSurg Collaborative

doi:10.1111/anae.16324

Association between multimorbidity and postoperative mortality in patients undergoing major surgery: a prospective study in 29 countries across Europe

Starsurg Collaborative, EuroSurg Collaborative

Anaesthesia Teaching & Research

Research output: Contribution to journal › Article › Research › peer-review

6 Citations (Scopus)

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.

Original language	English
Pages (from-to)	945-956
Number of pages	12
Journal	Anaesthesia
Volume	79
Issue number	9
DOIs	https://doi.org/10.1111/anae.16324
Publication status	Published - Sept 2024

Keywords

30-day mortality
mortality
multimorbidity
surgery

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1111/anae.16324Licence: CC BY

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@article{053cc6b5ecc04651812489bce9f0b898,

title = "Association between multimorbidity and postoperative mortality in patients undergoing major surgery: a prospective study in 29 countries across Europe",

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.",

keywords = "30-day mortality, mortality, multimorbidity, surgery",

author = "Kamarajah, {S. K.} and O. Kouli and S. Ahuja and S. Blackwell and J. Dhesi and A. Docherty and K. El-Boghdadly and Glasbey, {J. C.} and McLean, {K. A.} and Moonesinghe, {S. R.} and B. Morton and S. Moug and K. Nirantharakumar and T. Pinkney and S. Spencer and J. Yeung and Harrison, {E. M.} and A. Bhangu and Morton, {D. G.} and Knight, {S. R.} and R. Blanco-Colino and N. Brindl and S. Brown and Cambridge, {W. A.} and D. Chaudhry and K. Gressmann and Gujjuri, {R. R.} and A. Hilder and A. Jaffer and I. Jakaityte and M. Kawka and E. Matey and A. Mergo and Mills, {E. C.} and V. Murray and Ooi, {S. Z.Y.} and Pereira, {I. S.} and Riad, {A. M.} and A. Sgr{\`o} and Shafi, {S. Q.} and I. Trout and A. Tur{\v n}a and C. Varghese and W. Xu and Biccard, {B. M.} and J. Martin and M. Phull and R. Mouton and A. Bhangu and N. Smart and T. Richards and I. Dajti and {de Cillia}, M. and {Van Ramshorst}, G. and S. Delibegovic and H. Mughal and J. Mihanovic and N. Gouvas and P. Kocian and V. Levesen and J. Kaupilla and D. Merz and M. Joos and A. Ioannidis and G. Nnaji and F. Pata and G. Pellino and A. Gori and M. Podda and C. Riboni and E. Fekaj and {Oliver Senica}, S. and A. Dauksa and J. Psaila and {de Ruitjer}, F. and P. Major and I. Santos and {Sampaio Alves}, M. and J. Sim{\~o}es and Bonci, {E. A.} and A. Pașca and A. Novikova and B. Kova{\v c}evi{\'c} and V. Milosavljevic and B. Tadic and J. Kosir and {P{\'e}rez Ajates}, S. and OssolaRevilla, {M. E.} and A. Papadia and Gasparri, {M. L.} and Aktas, {M. K.} and Baki, {B. E.} and Tepe, {M. D.} and Mutlu, {A. U.} and A. Singal and J. Osei-Bonsu and H. Lacey and Chan, {S. W.} and M. Allison and K. Duah-Asante and D. Chen and N. Ahmed and A. Ejiz and C. Takyi and M. Mujeeb and N. Ravikumar and M. Khan and J. Hayes and J. Mckenna and J. Wang and N. Essa and H. Xianghan and L. Ko and Y. Aldabbagh and J. Plascevic and N. Zia and R. Ismail and Y. Kamel and I. Epanomeritakis and R. Tan and N. Chiu and A. Naeem and M. Kakwani and R. Mehra and K. Feeney and {Yan Naing}, {C. L.} and A. Qureshi and A. Richens and H. Li and R. Ahmed and L. Wilson and S. Abraha and S. Mikalauskas and J. Kahn and D. Kniepeiss and M. Ku{\v s}ar and A. Belarmino and J. Frenk and I. Mikalauskiene and A. Angelis and Waha, {J. E.} and S. Al-Sharafy and M. Sandano and P. Schemmer and C. Reiterer and K. Horvath and A. Taschner and S. Riss and F. Harpain and C. Dawoud and N. Hant{\'a}kov{\'a} and N. Adamowitsch and S. Schallmeiner and T. Christian and V. Xu and Kuhrn, {M. M.} and Widmann, {K. M.} and B. Capek and B. Kama and S. Turgut and L. Hauptmann and M. Gr{\"u}nbart and H. Hoi and A. Binder and T. G{\"u}rtler and P. Riedl and D. Mayer and {Van Belle}, K. and O. Wautelet and E. Dekkers and {Van Daele}, E. and T. Apers and F. Berrevoet and N. Rennie and P. Dries and P. Panta and A. Denys and W. Pype and T. Bauwens and N. Renard and S. Violon and J. Stijns and {Van De Winkel}, T. and {Van Eetvelde}, E. and M. Salibasic and S. Pusina and E. Hod{\v z}i{\'c} and M. Kru{\v s}{\v c}ica and S. {\v Z}ili{\'c} and E. Bicakcic and A. Rovcanin and E. Kulovic and E. Halilovic and {Vin{\v c}evi{\'c} Hod{\v z}i{\'c}}, A. and E. Kalbi{\'c} and A. Muji{\'c} and M. Me{\v s}an and E. Matovi{\'c} and A. Kesetovic and D. Dardanov and E. Arabadzhieva and B. Markov and Спасова and C. Biji and N. Oliveira and V. Miroslavov and G. Korukov and K. Ravendran and N. Shah and Y. Mitkov and K. Arivanandan and R. Gaikwad and S. Gotru and R. Saraff and N. Sain and D. Stanchev and L. Gaydarski and U. Ali and Kandathil, {L. J.} and A. Krishnaveni and I. Ivanov and I. Ganev and Krapeshki and M. Miza and Mumu, {M. S.K.} and I. Bashliev and A. Sajjad and L. Chandel and D. Yordanov and E. Hristova and K. Spassov and T. Tsankov and T. Ivanov and E. Filipov and D. Georgiev and V. Neykov and E. Daleva and I. Ilieva and D. Krasimirova and H. Hristov and Арсова and O. Soladoye and A. Biswakarma and R. Raj and A. Negi and A. Dey and Adidela, {J. K.} and {Starsurg Collaborative} and {EuroSurg Collaborative}",

note = "Publisher Copyright: {\textcopyright} 2024 The Authors. Anaesthesia published by John Wiley & Sons Ltd on behalf of Association of Anaesthetists.",

year = "2024",

month = sep,

doi = "10.1111/anae.16324",

language = "English",

volume = "79",

pages = "945--956",

journal = "Anaesthesia",

issn = "0003-2409",

publisher = "Wiley-Blackwell",

number = "9",

}

TY - JOUR

T1 - Association between multimorbidity and postoperative mortality in patients undergoing major surgery

T2 - a prospective study in 29 countries across Europe

AU - Kamarajah, S. K.

AU - Kouli, O.

AU - Ahuja, S.

AU - Blackwell, S.

AU - Dhesi, J.

AU - Docherty, A.

AU - El-Boghdadly, K.

AU - Glasbey, J. C.

AU - McLean, K. A.

AU - Moonesinghe, S. R.

AU - Morton, B.

AU - Moug, S.

AU - Nirantharakumar, K.

AU - Pinkney, T.

AU - Spencer, S.

AU - Yeung, J.

AU - Harrison, E. M.

AU - Bhangu, A.

AU - Morton, D. G.

AU - Knight, S. R.

AU - Blanco-Colino, R.

AU - Brindl, N.

AU - Brown, S.

AU - Cambridge, W. A.

AU - Chaudhry, D.

AU - Gressmann, K.

AU - Gujjuri, R. R.

AU - Hilder, A.

AU - Jaffer, A.

AU - Jakaityte, I.

AU - Kawka, M.

AU - Matey, E.

AU - Mergo, A.

AU - Mills, E. C.

AU - Murray, V.

AU - Ooi, S. Z.Y.

AU - Pereira, I. S.

AU - Riad, A. M.

AU - Sgrò, A.

AU - Shafi, S. Q.

AU - Trout, I.

AU - Turňa, A.

AU - Varghese, C.

AU - Xu, W.

AU - Biccard, B. M.

AU - Martin, J.

AU - Phull, M.

AU - Mouton, R.

AU - Bhangu, A.

AU - Smart, N.

AU - Richards, T.

AU - Dajti, I.

AU - de Cillia, M.

AU - Van Ramshorst, G.

AU - Delibegovic, S.

AU - Mughal, H.

AU - Mihanovic, J.

AU - Gouvas, N.

AU - Kocian, P.

AU - Levesen, V.

AU - Kaupilla, J.

AU - Merz, D.

AU - Joos, M.

AU - Ioannidis, A.

AU - Nnaji, G.

AU - Pata, F.

AU - Pellino, G.

AU - Gori, A.

AU - Podda, M.

AU - Riboni, C.

AU - Fekaj, E.

AU - Oliver Senica, S.

AU - Dauksa, A.

AU - Psaila, J.

AU - de Ruitjer, F.

AU - Major, P.

AU - Santos, I.

AU - Sampaio Alves, M.

AU - Simões, J.

AU - Bonci, E. A.

AU - Pașca, A.

AU - Novikova, A.

AU - Kovačević, B.

AU - Milosavljevic, V.

AU - Tadic, B.

AU - Kosir, J.

AU - Pérez Ajates, S.

AU - OssolaRevilla, M. E.

AU - Papadia, A.

AU - Gasparri, M. L.

AU - Aktas, M. K.

AU - Baki, B. E.

AU - Tepe, M. D.

AU - Mutlu, A. U.

AU - Singal, A.

AU - Osei-Bonsu, J.

AU - Lacey, H.

AU - Chan, S. W.

AU - Allison, M.

AU - Duah-Asante, K.

AU - Chen, D.

AU - Ahmed, N.

AU - Ejiz, A.

AU - Takyi, C.

AU - Mujeeb, M.

AU - Ravikumar, N.

AU - Khan, M.

AU - Hayes, J.

AU - Mckenna, J.

AU - Wang, J.

AU - Essa, N.

AU - Xianghan, H.

AU - Ko, L.

AU - Aldabbagh, Y.

AU - Plascevic, J.

AU - Zia, N.

AU - Ismail, R.

AU - Kamel, Y.

AU - Epanomeritakis, I.

AU - Tan, R.

AU - Chiu, N.

AU - Naeem, A.

AU - Kakwani, M.

AU - Mehra, R.

AU - Feeney, K.

AU - Yan Naing, C. L.

AU - Qureshi, A.

AU - Richens, A.

AU - Li, H.

AU - Ahmed, R.

AU - Wilson, L.

AU - Abraha, S.

AU - Mikalauskas, S.

AU - Kahn, J.

AU - Kniepeiss, D.

AU - Kušar, M.

AU - Belarmino, A.

AU - Frenk, J.

AU - Mikalauskiene, I.

AU - Angelis, A.

AU - Waha, J. E.

AU - Al-Sharafy, S.

AU - Sandano, M.

AU - Schemmer, P.

AU - Reiterer, C.

AU - Horvath, K.

AU - Taschner, A.

AU - Riss, S.

AU - Harpain, F.

AU - Dawoud, C.

AU - Hantáková, N.

AU - Adamowitsch, N.

AU - Schallmeiner, S.

AU - Christian, T.

AU - Xu, V.

AU - Kuhrn, M. M.

AU - Widmann, K. M.

AU - Capek, B.

AU - Kama, B.

AU - Turgut, S.

AU - Hauptmann, L.

AU - Grünbart, M.

AU - Hoi, H.

AU - Binder, A.

AU - Gürtler, T.

AU - Riedl, P.

AU - Mayer, D.

AU - Van Belle, K.

AU - Wautelet, O.

AU - Dekkers, E.

AU - Van Daele, E.

AU - Apers, T.

AU - Berrevoet, F.

AU - Rennie, N.

AU - Dries, P.

AU - Panta, P.

AU - Denys, A.

AU - Pype, W.

AU - Bauwens, T.

AU - Renard, N.

AU - Violon, S.

AU - Stijns, J.

AU - Van De Winkel, T.

AU - Van Eetvelde, E.

AU - Salibasic, M.

AU - Pusina, S.

AU - Hodžić, E.

AU - Kruščica, M.

AU - Žilić, S.

AU - Bicakcic, E.

AU - Rovcanin, A.

AU - Kulovic, E.

AU - Halilovic, E.

AU - Vinčević Hodžić, A.

AU - Kalbić, E.

AU - Mujić, A.

AU - Mešan, M.

AU - Matović, E.

AU - Kesetovic, A.

AU - Dardanov, D.

AU - Arabadzhieva, E.

AU - Markov, B.

AU - Спасова, null

AU - Biji, C.

AU - Oliveira, N.

AU - Miroslavov, V.

AU - Korukov, G.

AU - Ravendran, K.

AU - Shah, N.

AU - Mitkov, Y.

AU - Arivanandan, K.

AU - Gaikwad, R.

AU - Gotru, S.

AU - Saraff, R.

AU - Sain, N.

AU - Stanchev, D.

AU - Gaydarski, L.

AU - Ali, U.

AU - Kandathil, L. J.

AU - Krishnaveni, A.

AU - Ivanov, I.

AU - Ganev, I.

AU - Krapeshki, null

AU - Miza, M.

AU - Mumu, M. S.K.

AU - Bashliev, I.

AU - Sajjad, A.

AU - Chandel, L.

AU - Yordanov, D.

AU - Hristova, E.

AU - Spassov, K.

AU - Tsankov, T.

AU - Ivanov, T.

AU - Filipov, E.

AU - Georgiev, D.

AU - Neykov, V.

AU - Daleva, E.

AU - Ilieva, I.

AU - Krasimirova, D.

AU - Hristov, H.

AU - Арсова, null

AU - Soladoye, O.

AU - Biswakarma, A.

AU - Raj, R.

AU - Negi, A.

AU - Dey, A.

AU - Adidela, J. K.

AU - Starsurg Collaborative

AU - EuroSurg Collaborative

PY - 2024/9

Y1 - 2024/9

N2 - 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.

AB - 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.

KW - 30-day mortality

KW - mortality

KW - multimorbidity

KW - surgery

UR - http://www.scopus.com/inward/record.url?scp=85194577170&partnerID=8YFLogxK

U2 - 10.1111/anae.16324

DO - 10.1111/anae.16324

M3 - Article

C2 - 39101671

AN - SCOPUS:85194577170

SN - 0003-2409

VL - 79

SP - 945

EP - 956

JO - Anaesthesia

JF - Anaesthesia

IS - 9

ER -

Association between multimorbidity and postoperative mortality in patients undergoing major surgery: a prospective study in 29 countries across Europe

Abstract

Keywords

UN SDGs

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