Inpatient Palliative Care and Post-operative Healthcare Utilization Among Older Surgical Patients

Area of Science:

• Geriatric Medicine
• Palliative Care
• Health Services Research

Background:

• National guidelines advocate for palliative care processes in seriously ill patients undergoing major surgery.
• Outcomes of palliative care for elective surgical patients remain understudied.

Purpose of the Study:

• To examine the association between documented palliative care processes and post-discharge healthcare utilization.
• To assess changes in healthcare utilization among seriously ill older adults after major elective surgeries.

Main Methods:

• Retrospective, multicenter study utilizing Natural Language Processing (NLP) on electronic health records.
• Identified five palliative care processes: goals of care, code status, palliative care consultation, hospice assessment, and surrogate decision-maker designation.
• Analyzed Medicare claims for one-year post-discharge healthcare utilization in older adults undergoing major elective surgeries (2016-2018).

Main Results:

• Among 1,082 patients, surrogate decision-maker designation was most common (54.1%), while palliative care consultations and hospice assessments were rare (<2.0%).
• Documented surrogate decision-makers were not associated with significant changes in hospital days, days at home, or ED visits.
• Patients with documented code status limitations spent fewer days at home (314.9 vs. 338.6, P=0.004).

Conclusions:

• Inpatient palliative care processes, including surrogate decision-maker designation, showed no association with changes in one-year healthcare utilization post-elective surgery.
• Findings suggest current palliative care documentation in this cohort may not influence short-term healthcare utilization outcomes.