Palliative Care and Hospice Patterns in Multimorbid Emergency General Surgery Patients

Emergency general surgery (EGS) patients are at high-risk of poor outcomes, contributing to challenges in decision-making in this population. In high-risk, nonsurgical populations, palliative care (PC) has been effective in improving outcomes. Given the high rates of poor outcomes among EGS patients, PC may be highly relevant in this context. This study examines PC and hospice utilization across operative and nonoperative hospitalizations of multimorbid EGS patients.

This was a retrospective cohort study of multimorbid, EGS adults hospitalized between 2016 and 2021 using the Healthcare Cost and Utilization Project State Inpatient Database (Arkansas, Florida, Iowa, Maryland, Massachusetts, New York, Utah, Vermont, Washington, Wisconsin). Receipt of PC was determined using ICD-10 codes. PC utilization was compared by clinical characteristics. Two subgroup analyses were performed. One including multimorbid, EGS patients without a cancer diagnosis and a second including PC patients who survived the index hospitalization.

Of the 702,612 patients included in the cohort, 39,485 (5.6%) received PC. Patients who received PC were older (mean 76 versus 69 y, P < 0.001) and less likely to receive operative treatment (4.2% versus 5.9%, P < 0.001) than those who did not. PC utilization significantly increased over time: 5.3% (2016) to 6.2% (2021). The diagnoses associated with greatest PC utilization were neoplasm and hepatic conditions. Patients with specific comorbidities (metastatic cancer, dementia) were significantly more likely to receive PC. PC utilization patterns differed after exclusion of cancer patients. Of the PC patients who survived index hospitalization, 53.6% were enrolled in hospice.

Certain clinical characteristics are associated with higher PC and hospice utilization in multimorbid EGS patients, but PC use remains low. This data suggests opportunities to develop selection criteria for PC referrals.