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Functional Status is Key to Long-Term Survival In Emergency General Surgery Conditions
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3 2023
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Source: J Surg Res. 283:224-232
[PDF-582.39 KB]
Details:
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Alternative Title:J Surg Res
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Personal Author:
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Description:Background:
Emergency General Surgery (EGS) conditions in older patients constitutes a substantial public health burden due to high morbidity and mortality. We sought to utilize a supervised machine learning method to determine combinations of factors with the greatest influence on long-term survival in older EGS patients.
Methods:
We identified community dwelling participants admitted for EGS conditions from the Medicare Current Beneficiary Survey linked with claims (1992–2013). We categorized 3 binary domains of multimorbidity: chronic conditions, functional limitations, and geriatric syndromes (such as vision/hearing impairment, falls, incontinence). We also collected EGS disease type, age, and sex. We created a classification and regression tree (CART) model to identify groups of variables associated with our outcome of interest, 3-year survival. We then performed Cox proportional hazards analysis to determine hazard ratios for each group, with the lowest risk group as reference.
Results:
We identified 1,960 patients (median age 79 [IQR: 73, 85], 59.5% female). The CART model identified the presence of functional limitations as the primary splitting variable. The lowest risk group were patient aged ≤81 with biliopancreatic disease and without functional limitations. The highest risk group was men aged ≥75 with functional limitations (HR 11.09 (95% CI 5.91–20.83). Notably absent from the CART model were chronic conditions and geriatric syndromes.
Conclusions:
More than the presence of chronic conditions or geriatric syndromes, functional limitations are an important predictor of long-term survival and must be included in pre-surgical assessment.
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Pubmed ID:36423470
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Pubmed Central ID:PMC9923717
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Volume:283
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