Please use this identifier to cite or link to this item: http://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
RMID: 0030022489
DOI: 10.1111/ans.12726
Grant ID: http://purl.org/au-research/grants/nhmrc/1025140
Appears in Collections:Public Health publications

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