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

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dc.authoridAta, Batuhan / 0009-0006-5127-7474
dc.contributor.authorKamarajah, Sivesh K.
dc.contributor.authorKouli, Omar
dc.contributor.authorAhuja, Shalini
dc.contributor.authorBlackwell, Sue
dc.contributor.authorDhesi, Jugdeep Kaur
dc.contributor.authorMoonesinghe, Suneetha Ramani
dc.contributor.authorMorton, Ben
dc.contributor.authorAta, Batuhan
dc.date.accessioned2026-02-03T11:53:39Z
dc.date.available2026-02-03T11:53:39Z
dc.date.issued2024
dc.departmentÇanakkale Onsekiz Mart Üniversitesi
dc.descriptionSTARSurg Collaborative, EuroSurg Collaborative
dc.description.abstractBackground 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.
dc.description.sponsorshipRoyal College of Surgeons of Edinburgh, RCSEd
dc.description.sponsorshipNational Institute for Health and Care Research, NIHR, (NIHR303288)
dc.description.sponsorshipNational Institute for Health and Care Research, NIHR
dc.description.sponsorshipWellcome Trust, WT, (203919/Z/16/Z)
dc.description.sponsorshipWellcome Trust, WT
dc.description.sponsorship(NIHR201708)
dc.identifier.doi10.1111/anae.16324
dc.identifier.endpage956
dc.identifier.issn0003-2409
dc.identifier.issue9
dc.identifier.pmid39101671
dc.identifier.scopus2-s2.0-85194577170
dc.identifier.scopusqualityQ1
dc.identifier.startpage945
dc.identifier.urihttps://doi.org/10.1111/anae.16324
dc.identifier.urihttps://hdl.handle.net/20.500.12428/34281
dc.identifier.volume79
dc.indekslendigikaynakScopus
dc.indekslendigikaynakPubMed
dc.language.isoen
dc.publisherJohn Wiley and Sons Inc
dc.relation.ispartofAnaesthesia
dc.relation.publicationcategoryMakale - Uluslararası Hakemli Dergi - Kurum Öğretim Elemanı
dc.rightsinfo:eu-repo/semantics/openAccess
dc.snmzKA_Scopus_20260130
dc.subject30-day mortality
dc.subjectmortality
dc.subjectmultimorbidity
dc.subjectsurgery
dc.titleAssociation between multimorbidity and postoperative mortality in patients undergoing major surgery: a prospective study in 29 countries across Europe
dc.typeArticle

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