Multimorbidity, healthcare utilization, and quality of life for older patients undergoing surgery: A prospective study

Multimorbidity (>= 2 chronic illnesses) is a worldwide healthcare challenge. Patients with multimorbidity have a reduced quality of life and higher mortality than healthy patients and use healthcare resources more intensively. This study investigated the prevalence of multimorbidity; examined the effects of multimorbidity on healthcare utilization; healthcare costs of multimorbidity; and compared the associations between the health-related quality of life (HRQoL) of older patients undergoing surgery and multimorbidity, the Charlson Comorbidity Index (CCI), the Simple Frailty Questionnaire (FRAIL), and the American Society of Anesthesiologists (ASA) physical status classifications. This prospective cohort study enrolled 360 patients aged > 65 years scheduled for surgery at a university hospital. Data were collected on their demographics, preoperative medical profiles, healthcare costs, and healthcare utilization (the quantification or description of the use of services, such as the number of preoperative visits, multiple-department consultations, surgery waiting time, and hospital length of stay). Preoperative-assessment data were collected via the CCI, FRAIL questionnaire, and ASA classification. HRQoL was derived using the EQ-5D-5L questionnaire. The 360 patients had a mean age of 73.9 +/- 6.6 years, and 37.8% were men. Multimorbidity was found in 285 (79%) patients. The presence of multimorbidity had a significant effect on healthcare utilization (>= 2 preoperative visits and consultations with >= 2 departments). However, there was no significant difference in healthcare costs between patients with and without multimorbidity. At the 3-month postoperative, patients without multimorbidity had significantly higher scores for HRQoL compared to those with multimorbidity (HRQoL = 1.00 vs 0.96; P < .007). While, patients with ASA Class > 2 had a significantly lower median HRQoL than patients with ASA Class <= 2 at postoperative day 5 (HRQoL = 0.76; P = .018), 1-month (HRQoL = 0.90; P = .001), and 3-months (HRQoL = 0.96; P < .001) postoperatively. Multimorbidity was associated with a significant increase in the healthcare utilization of the number of preoperative visits and a greater need for multiple-department consultations. In addition, multimorbidity resulted in a reduced HRQoL during hospital admission and 3-months postoperatively. In particular, the ASA classification > 2 apparently reduced postoperative HRQoL at day 5, 1-month, and 3-months lower than the ASA classification <= 2.

Automated summary

Multimorbidity is a global healthcare challenge, leading to reduced quality of life, higher mortality rates, and intensive use of healthcare resources. This study examined the prevalence of multimorbidity, its impact on healthcare utilization and costs, and the relationships between health-related quality of life (HRQoL) and multimorbidity, Charlson Comorbidity Index (CCI), Simple Frailty Questionnaire (FRAIL), and American Society of Anesthesiologists (ASA) physical status classifications in older surgical patients. The results showed that multimorbidity was associated with increased healthcare utilization (multiple preoperative visits and multi-department consultations), but not with significant differences in healthcare costs. Patients without multimorbidity had higher HRQoL scores at 3 months postoperatively, while those with ASA Class >2 had lower HRQoL scores at postoperative day 5, 1 month, and 3 months compared to those with ASA Class <=2.