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The Impact of Medical Co-morbidities Upon Surgical Outcomes. An Analysis of the Rhode Island Hospital NSQIP Database
*Larissa C Chiulli, *Andrew H. Stephen, *Daithi S. Heffernan, Thomas J Miner
Rhode Island Hospital, Providence, RI
Objective: Medical Co-Morbidities (MCMs) impact outcomes of hospitalized patients. Despite the aging of the US population, early diagnosis and advances in health maintenance have dulled the impact of MCMs on overall health. Understanding the impact of MCMs on surgical patients will offer better pre-operative risk stratification and patient counseling.
Design: A retrospective review of a single center NSQIP database including age, gender and all comorbidities.
Setting: University Hospital
Patients: Admitted adult surgical patients from 2008 to 2013.
Interventions: none
Main Outcomes Measure: All complications occurring during the hospital stay
Results: 7,763 patients, 46% male, average age 55.9years. 52% had MCMs (average=1.4 per patient). 1,098(14.1%) patients had at least one complication. Patients with complications were older(63.1 vs 54.6 years;p<0.001), more likely male(54% vs 44%;p<0.001), had higher ASA score (2.8 vs 2.1;p<0.001) and higher rates of MCMs(1.6 vs 1.4;p<0.001). Adjusting for age, gender, ASA class and number of MCMs, the risk of a complication following surgery was associated with renal failure (OR1.4; 95%CI=1.02-1.97), steroid use (OR1.89; 95%CI=1.41-2.53), and Congestive Heart Failure(OR2.48; 95%CI=1.19-5.14), but not diabetes (OR0.98; 95%CI=0.82-1.18), hypertension(OR0.89; 95%CI=0.76-1.06) or COPD (OR 1.129; 95%CI=0.86-1.48). Further, the number of complications that occurred was significantly higher in patients with obesity, CHF and higher ASA class, but not in diabetic or COPD patients.
Conclusions: Chronic, and presumably well managed MCMs (diabetes, hypertension and COPD) were not associated with increased risks of post-operative complications. Pre-operative CHF or renal failure may reflect end organ failure resulting from poor control of these aforementioned MCMs. In the advent of universal health coverage we advocate expanded awareness and aggressive management of diabetes, lung disease, and hypertension.
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