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

Abstract

To determine associations between documented palliative care processes and changes in post-discharge healthcare utilization among a cohort of seriously ill older adults after common major elective surgeries. National guidelines recommend palliative care processes for patients with serious illness undergoing major surgery. However, outcomes associated with palliative care delivery to elective surgical patients are understudied. We conducted a retrospective, multicenter study using Natural Language Processing to identify electronic health record documentation of five palliative care processes in a cohort of older adults with serious illness who underwent one of five major elective surgeries in a large regional health system between 2016-2018. The processes included: (1) Goals of care conversation, (2) Code status limitation, (3) Palliative care consultation, (4) Hospice assessment, and (5) Surrogate decision-maker designation. We used Medicare claims to assess healthcare utilization one-year post-discharge. Among 1,082 patients, 54.1% had a documented surrogate decision-maker, 4.3% had code status limitations, 2.6% had goals of care conversations, and<2.0% had assessment for hospice or palliative care consultations. In adjusted analysis, patients with documented surrogate decision-maker had no significant changes in hospital days, days at home, or ED visits in the year following surgery. Patients who had documented code status limitations alone spent significantly fewer days at home than those who did not (314.9 vs. 338.6, P=0.004). Inpatient palliative care processes such as surrogate decision maker-designation are not associated with changes in one-year healthcare utilization after elective surgery.