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https://hdl.handle.net/2440/92302
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Type: | Journal article |
Title: | Managing high-risk surgical patients: modifiable co-morbidities matter |
Author: | Pham, C. Gibb, C. Field, J. Gray, J. Fitridge, R. Marshall, V. Karnon, J. |
Citation: | ANZ Journal of Surgery, 2014; 84(12):925-931 |
Publisher: | Wiley |
Issue Date: | 2014 |
ISSN: | 1445-1433 1445-2197 |
Statement of Responsibility: | Clarabelle Pham, Catherine Gibb, John Field, Jodi Gray, Robert Fitridge, Villis Marshall and Jonathan Karnon |
Abstract: | BACKGROUND: There are a subset of potentially modifiable co-morbidities that may be targeted in the preoperative phase with a view to optimizing control and improving post-operative outcomes. This study aims to estimate the effect of potentially modifiable co-morbidities on post-operative outcomes and to identify potential targets for preoperative management. METHODS: Retrospective data on hospital separations in South Australia were analyzed using multiple regression to estimate the association between nine potentially modifiable co-morbidities and length of stay, post-operative complications and in-hospital mortality. RESULTS: After adjusting for primary diagnosis, age, gender and other potential confounders, significant increases in length of stay and complications were recorded for eight and six of the nine modifiable co-morbidities, respectively. As examples, previous heart failure was associated with a 54% increase in length of stay and an odds ratio of 1.75 for complications. Asthma and chronic obstructive pulmonary disease was associated with a 38% increase in length of stay and an odds ratio of 1.64 for complications. CONCLUSIONS: A set of potentially modifiable co-morbidities is associated with a range of poorer post-operative outcomes, relative to patients without those co-morbidities. There is a clinical rationale that outcomes will be worse in the subset of patients for whom such co-morbidities are poorly controlled, and that timely intervention to improve control in the period prior to surgery will improve post-operative outcomes. Further research is required on post-operative outcomes for patients with and without controlled co-morbidities and on the effects of timely intervention to improve control prior to surgery. |
Keywords: | co-morbidity optimization outcome preoperative care |
Rights: | © 2014 Royal Australasian College of Surgeons |
DOI: | 10.1111/ans.12726 |
Grant ID: | http://purl.org/au-research/grants/nhmrc/1025140 |
Published version: | http://dx.doi.org/10.1111/ans.12726 |
Appears in Collections: | Aurora harvest 2 Public Health publications |
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