Clinical

Postop palliative care may improve outcomes for those undergoing high-risk surgery


 

Background: In the final year before death, surgery is common for many patients. Prior studies have shown that fewer than 38% of surgical patients receive palliative care services before death. Palliative care involvement has been shown to improve quality of life and coordination of care in surgical patients.

Study design: Retrospective cross-sectional analysis of administrative data.

Setting: 129 Veteran Affairs medical centers.

Synopsis: In a retrospective review of 95,204 patients who underwent high-risk surgical procedures, the authors identified a 90-day mortality rate of 6.0%. Only 3.5% of patients received a perioperative palliative care consult. Multivariate analysis of bereaved family survey scores of patients who died within 90 days of surgery showed that families of patients who received a palliative care consult were significantly more likely to rate the care (odds ratio, 1.47), end-of-life communication (OR, 1.43), and support (OR, 1.31) as excellent, compared with those who did not. The use of survey responses and the Veteran Affairs population possibly introduces selection bias and limitations to the generalizability of the study.

Bottom line: Palliative care consultation for patients undergoing high-risk surgery remains underutilized but may be beneficial for patients.

Citation: Yefimova M et al. Palliative care and end-of-life outcomes following high-risk surgery. JAMA Surg. 2020 Jan 2;155(2):138-46.

Dr. Halford is a hospitalist at Beth Israel Deaconess Medical Center, and instructor in medicine, Harvard Medical School, both in Boston.

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