Robbins AJ, Beilman GJ, Ditta T, Benner A, Rosielle D, Chipman J, Lusczek E. Mortality After Elective Surgery: The Potential Role for Preoperative Palliative Care.
J Surg Res 2021;
266:44-53. [PMID:
33984730 DOI:
10.1016/j.jss.2021.04.003]
[Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 04/02/2021] [Accepted: 04/02/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND
Preoperative optimization is increasingly emphasized for high-risk surgical patients. One critical component of this includes preoperative advanced care planning to promote goal-concordant care. We aimed to define a subset of patients that might benefit from preoperative palliative care consult for advanced care planning.
MATERIALS AND METHODS
We examined adult patients admitted from January 2016 to December 2018 to a university health system for elective surgery. Multivariate logistic regression was used to identify variables associated with death within 1 y, and presence of palliative care consults preoperatively. Chi-square analysis evaluated the impact of a palliative care consult on advanced care planning variables.
RESULTS
Of the 29,132 inpatient elective procedures performed, there was a 2.0% mortality rate at 6 mo and 3.5% at 1 y. Those who died were more likely to be older, male, underweight (BMI <18), or have undergone an otolaryngology, neurosurgery or thoracic procedure type (all P-values < 0.05). At the time of admission, 29% had an advance directive, 90% had a documented code status, and 0.3% had a preoperative palliative care consult. Patients were more likely to have an advanced directive, a power of attorney, a documented code status, and have a do not resuscitate order if they had a palliative care consult (all P-values <0.05). The mortality rates and preoperative palliative care rates per procedure type did not follow similar trends.
CONCLUSIONS
Preoperative palliative care consultation before elective admissions for surgery had a significant impact on advanced care planning.
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