{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T08:50:00Z","timestamp":1791363000643,"version":"4.3.1"},"reference-count":38,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2018,12,2]],"date-time":"2018-12-02T00:00:00Z","timestamp":1543708800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100006108","name":"National Center for Advancing Translational Sciences","doi-asserted-by":"publisher","award":["KL2TR000440"],"award-info":[{"award-number":["KL2TR000440"]}],"id":[{"id":"10.13039\/100006108","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["agsjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J American Geriatrics Society"],"published-print":{"date-parts":[[2019,3]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND\/OBJECTIVES<\/jats:title>\n                    <jats:p>Over a million older patients in the United States are admitted yearly for emergency general surgery (EGS) conditions. Seven procedure types dominate: colon, small bowel, gallbladder, ulcer disease, adhesiolysis, appendix, and laparotomy operations. A higher comorbidity burden is known to increase mortality in this population, but the impact of specific comorbidity combinations is unknown. Our objectives were to (1) characterize the distribution of procedures, comorbidities, and outcomes for older patients undergoing EGS; and (2) apply a data\u2010driven approach (association rule mining) to identify comorbidity combinations associated with disproportionately high mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>DESIGN, SETTING, AND PARTICIPANTS<\/jats:title>\n                    <jats:p>Cross\u2010sectional study of patients 65 years and older who underwent one of the seven procedures previously cited, taken from the 2011 Nationwide Inpatient Sample. A total of 280 885 patient encounters were identified.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>MEASUREMENTS<\/jats:title>\n                    <jats:p>In\u2010hospital mortality, procedures, and comorbidities based on the Elixhauser Comorbidity Index.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>\n                      Overall mortality was 5.6%. The most common procedures were gallbladder (33.7%), ulcer surgery (21.5%), and adhesiolysis (21.0%). Mortality increased for all procedures as patients aged. Comorbidities associated with the highest mortality included coagulopathy (adjusted odds ratio [aOR] = 3.74; 95% confidence interval [CI] = 3.41\u20134.11;\n                      <jats:italic>p<\/jats:italic>\n                      &lt; .001), fluid and electrolyte disorders (FED) (aOR = 2.89; 95% CI = 3.66\u20133.14;\n                      <jats:italic>p<\/jats:italic>\n                      &lt; .001), and liver disease (aOR = 1.89; 95% CI = 1.61\u20132.22;\n                      <jats:italic>p<\/jats:italic>\n                      &lt; .001). Three\u2010way comorbidity combinations most highly associated with mortality were coagulopathy, FED, and peripheral vascular disease (aOR = 5.10; 95% CI = 4.17\u20136.24;\n                      <jats:italic>p<\/jats:italic>\n                      &lt; .001), and coagulopathy, FED, and chronic pulmonary disease (aOR = 4.83; 95% CI = 4.00\u20135.82;\n                      <jats:italic>p<\/jats:italic>\n                      &lt; .001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION<\/jats:title>\n                    <jats:p>For older patients, combinations of comorbidities portend additional risk beyond single comorbidities, and the associated risk burden is driven by the specific constellation of comorbidities present. Future work must continue to examine the effect of co\u2010occurring diseases to provide personalized and realistic prognostication for older patients undergoing EGS. J Am Geriatr Soc 67:503\u2013510, 2019.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jgs.15682","type":"journal-article","created":{"date-parts":[[2018,12,3]],"date-time":"2018-12-03T00:33:22Z","timestamp":1543797202000},"page":"503-510","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":82,"title":["High\u2010Risk Comorbidity Combinations in Older Patients Undergoing Emergency General Surgery"],"prefix":"10.1111","volume":"67","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6113-2555","authenticated-orcid":false,"given":"Vanessa P.","family":"Ho","sequence":"first","affiliation":[{"name":"Department of Surgery, Division of Trauma Critical Care, Burns, and Acute Care Surgery, MetroHealth Medical Center Cleveland Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas K.","family":"Schiltz","sequence":"additional","affiliation":[{"name":"Department of Population and Quantitative Health Sciences Case Western Reserve University School of Medicine Cleveland Ohio"},{"name":"Frances Payne Bolton School of Nursing Case Western Reserve University Cleveland Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew P.","family":"Reimer","sequence":"additional","affiliation":[{"name":"Frances Payne Bolton School of Nursing Case Western Reserve University Cleveland Ohio"},{"name":"Critical Care Transport Cleveland Clinic Cleveland Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth A.","family":"Madigan","sequence":"additional","affiliation":[{"name":"Sigma Theta Tau International Honor Society of Nursing Indianapolis Indiana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siran M.","family":"Koroukian","sequence":"additional","affiliation":[{"name":"Department of Population and Quantitative Health Sciences Case Western Reserve University School of Medicine Cleveland Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,12,2]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0000000000000362"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2016.0480"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1001\/archsurg.2009.204"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0000000000000787"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.5888\/pcd12.140388"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0000000000000555"},{"key":"e_1_2_6_8_1","unstructured":"2011 Introduction to the NIS. 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