Greater levels of co-morbidity and, to a lesser extent, socio-economic deprivation have an adverse effect on outcomes for patients admitted for emergency general surgery, suggests a study published in Trauma Surgery & Acute Care Open.
The researchers accessed national data for Scotland on adult patients admitted to hospital as an emergency under the care of a general surgeon between 1997 and 2016. Only 26.9 per cent of admissions had surgery.
In total, 1,477,810 admissions were analysed, of which 16.2 per cent involved patients in the most deprived group and 5.6 per cent involved those in the least deprived group.
Three quarters (75.6%) of patients had no co-morbidity, 20.3 per cent had mild co-morbidity (a single condition), 2.5 per cent had moderate co-morbidity (two mild co-morbidities or a more serious single condition) and 1.6 per cent had severe co-morbidity (multiple conditions and likely at least one of them severe).
Death rates while in hospital, and within 30 days, 90 days and one year were 1.7, 3.7, 7.2 and 12.4 per cent, respectively. More than three-quarters (78.6%) of patients were directly discharged home.
Analysis of the data revealed that patients with severe comorbidity were 13 times more likely to die in hospital.
Compared with patients from the most affluent areas, patients from the most deprived areas were less likely to be discharged directly to home and more than a third were more likely to die in hospital.
The authors conclude that patients with multi-morbidity are at increased risk of in-hospital, short-term and medium-term mortality. They are also at a higher risk of discharge to a non-home environment.
“Clinicians need to better appreciate (and quantify) the impact that comorbidity and, to a lesser extent, socioeconomic deprivation have on LOS, discharge destination and both in-hospital and post-discharge mortality,” they say.
