Crucial Conversations for High-Risk Populations before Surgery: Advance Care Planning in a Preoperative Setting

High-risk patients undergoing elective surgery are at risk for perioperative complications, including readmissions and death. Advance care planning (ACP) may allow for preparation for such events. (1) To assess the completion rate of advance directives (ADs) and their association with one year readmissions and mortality (2) to examine clinical events for decedents. This is an observational cohort study conducted through chart review. Subjects were 400 patients undergoing preoperative evaluation for elective surgery at two hospitals in the United States. The prevalence of ADs at the time of surgery and at one year, readmissions, and mortality at one year were determined. Three-hundred ninety patients were included. In total, 102 (26.4%) patients were readmitted, yet did not complete an AD. Seventeen (4.4%) patients filed an AD during follow-up. Nineteen patients died and mortality rate was 4.9%. There was a significant association between completing an AD before death. Of the decedents, seven (37%) underwent resuscitation, but only four had ADs. Many high-risk surgical patients would benefit from ADs before clinical decline. Preoperative clinics present a missed opportunity to ensure ACP occurs before complications arise.