The effect of palliative care involvement in vascular patients at the end of life.

Abstract

Vascular surgeons frequently manage critically ill patients and support complex end-of-life decision-making. Despite well-documented benefits of palliative care in serious illness, prior studies report that only 25% of patients receiving vascular surgery services near the end of life received such support. We evaluated the integration of palliative care for patients receiving vascular surgery services at the end of life, examining both utilization rates and its impact on care trajectories. Adult patients hospitalized at a tertiary academic medical center between January 1, 2017, and December 31, 2022, who received vascular surgery consultation or intervention and were determined to be near the end of life, defined as in-hospital death or discharge to inpatient or home hospice, were included. Patient demographics, comorbidities, admission problem, vascular intervention (consultation vs surgical intervention), intensive care unit stay, overall length of hospital stay, palliative consultation ordered, and discharge dispositions (such as hospital death without hospice, hospital death with hospice, and nonhospital death with hospice) were compared by palliative consultation utilization. The code status and goal of care before vs after palliative consultation among patients who received palliative consultation were compared. Of the 329 end-of-life patients, 196 (60.7%) received a palliative care consultation. Patients who received and those who did not receive palliative care were similar in terms of gender, race, ethnicity, and comorbidities. Although palliative care consultation did not affect whether a patient received vascular surgery, it did influence their care trajectory. Those without a palliative consultation were more likely to undergo a code (18.0% vs 6.6%; P = .001). After palliative consultation, the proportion of patients with a code status of do-not-resuscitate increased from 50.0% to 77.4%, and the proportion with a full code designation decreased from 50% to 22.6% (P < .001). Patients with the goal of care to allow natural death increased to more than half of the patients from 18.4% after the palliative consultation (P < .001). On multivariate analysis, patients admitted with a primary vascular diagnosis were more likely to receive palliative care consultation (odds ratio, 6.4; 95% confidence interval, 3.3-12.2; P < .001). An extended hospital stay (odds ratio, 1.1; P < .001) was associated with a higher likelihood of a palliative consultation order. Palliative care consultation was associated with significant changes in code status and goals-of-care decisions among patients receiving vascular surgery services at the end of life. These findings highlight an opportunity for vascular surgeons to proactively integrate palliative care, improving alignment between clinical interventions and patient preferences.