The Prevalence and Characterization of Comorbid Medical Conditions in Adult Patients Having Elective Surgery

Background: Identifying pre-surgery medical conditions has important implications for patient care, research, and policy. We hypothesized that modifiable medical conditions before surgery are common and under-recognized. Methods: : Adult patients scheduled for elective surgery in a single site academic tertiary hospital from January 2019 through December 2020 were screened for modifiable medical and lifestyle conditions by history and chart review and an electronic medical record (EMR) screening tool. The presence of a modifiable medical conditions was quantified and characterized by surgical site of service, ASA status, age, gender, race, visit type and surgical service. Patients screened for transplant, eye surgery, obstetric care, GI, or other “endoscopy” procedures, were excluded. If more than one surgery was performed, then only the first procedure was included. A logistic regression analysis was performed to evaluate the association of patient characteristics with odds of having any modifiable condition. P value less than 0.05 was considered significant. Agreement between history - chart review versus the EMR screening tool was compared using Cohen’s kappa coefficient. Patient characteristics associated with the presence of modifiable medical conditions were assessed using chi-squared tests. Results: : 19, 838 (63%) of 31,291 qualified patients evaluated had at least one modifiable medical condition or qualified for lifestyle modification. 76.5% of Inpatients had a modifiable condition versus 56.4% of outpatients. Older patients were more likely to have at least one modifiable medical condition (p<0.001) compared to younger patients and Black or African American patients were more likely to have at least one modifiable medical condition compared to Caucasian patients [OR 1.34 (1.26-1.44), (p<0.001). Site of service, age, gender, race, visit type and surgical service were independent predictors of a medical condition at the time of surgery. The likelihood of discovery of a medical condition was significantly greater with use of the EMR screening tool compared to a designation of a medical conditions based on chart review reliance alone (p<0.0001). Conclusion: The prevalence of co-existing and potentially modifiable co-morbid medical conditions among adult patients scheduled to undergo elective surgery is high regardless of surgery site of service with noteworthy differences among patient populations.