Mortality After Elective Surgery: The Potential Role for Preoperative Palliative Care
Alexandria J Robbins1, Gregory J Beilman1, Tatiana Ditta2
1Department of Surgery, University of Minnesota Medical School, Minneapolis, MN.
The Journal of Surgical Research
|May 13, 2021
Summary
Preoperative palliative care consults significantly improve advanced care planning for surgical patients. This proactive approach ensures goal-concordant care, especially for high-risk individuals undergoing elective surgery.
Area of Science:
- Surgical Oncology
- Palliative Care
- Health Services Research
Background:
- Preoperative optimization is crucial for high-risk surgical patients.
- Advanced care planning is essential for goal-concordant care.
- Identifying patients benefiting from palliative care consults for advanced care planning is key.
Purpose of the Study:
- To define a subset of surgical patients who would benefit from preoperative palliative care consults.
- To assess the impact of palliative care consults on advanced care planning.
Main Methods:
- Retrospective analysis of adult patients undergoing elective surgery from 2016-2018.
- Multivariate logistic regression to identify predictors of mortality and palliative care consults.
- Chi-square analysis to evaluate the impact of palliative care consults on advanced care planning.
Main Results:
- 3.5% mortality rate at 1 year post-surgery.
- Older age, male sex, underweight BMI, and specific procedures (otolaryngology, neurosurgery, thoracic) were associated with higher mortality.
- Only 0.3% of patients had a preoperative palliative care consult, but those who did were more likely to have advance directives, power of attorney, documented code status, and DNR orders.
Conclusions:
- Preoperative palliative care consultation significantly enhances advanced care planning in surgical patients.
- Palliative care consults are associated with better documentation of patient wishes and goals of care.
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