多发病对医疗保健服务提出了全球性挑战。本研究旨在描述当代接受腹部大手术的患者群体中多种疾病的患病率、常见疾病组合和结果。这是对一项前瞻性、多中心、国际研究的预先计划分析，该研究调查了在 2017 年进行的腹部大手术后的心血管并发症。欧洲 29 个国家的 446 家医院。主要结局是术后 30 天死亡率。次要结果指标是手术后 30 天内并发症的发生率。在 24,227 名患者中，7006 名患者 (28.9%) 患有一种长期疾病，10,486 名患者 (43.9%) 患有多种疾病（两种或多种长期健康状况）。最常见的病症是原发性癌症（39.6%）；高血压（37.9%）；慢性肾脏病（17.4%）；和糖尿病（15.4%）。与长期健康状况≤1的患者相比，患有多种疾病的患者虚弱的发生率更高。患有一种长期健康状况（调整后的比值比 1.93 (95%CI 1.16-3.23)）和多种疾病（调整后的比值比 2.22 (95%CI 1.35-3.64)）的患者死亡率较高。虚弱和 ASA 身体状况 3-5 介导了患有一种长期健康状况的患者 30 天死亡率的 31.7%（调整后比值比 1.30 (95%CI 1.12-1.51)），估计 30 天死亡率的 36.9%患有多种疾病的患者的日死亡率（调整后的比值比 1.61 (95%CI 1.36-1.91)）。接受术前医学评估的患有多种疾病的患者的 30 天死亡率没有改善。在欧洲各地的手术患者中，多种疾病很常见，而且结果很差。解决择期和急诊患者的多重发病问题需要创新策略来解决虚弱和疾病控制问题。多病患者迫切需要制定此类策略，整合针对整个手术路径的护理以加强现有系统。有必要进行介入试验来确定针对多发病手术患者的针对性治疗的有效性。© 2024 作者。约翰·威利出版的《麻醉》

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.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.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.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.© 2024 The Authors. Anaesthesia published by John Wiley & Sons Ltd on behalf of Association of Anaesthetists.