RS03 - Indications, Outcomes, and Mortality Among Single-Center Vascular Surgery Patients Utilizing Palliative Care Consultations

Wednesday, June 19, 2024

9:12 AM – 9:19 AM CT

Location: West Building, Level 3, Skyline Ballroom W375ab

Submitting & Presenting Author(s)

Rasikh N. Hamid, BS (he/him/his)

Medical Student
Department of Vascular and Endovascular Surgery, Wake Forest University School of Medicine, Winston-Salem, NC
Denmark, South Carolina

Co-Author(s)

EN

Estefania G. Narvaez

Clinical Researcher
Department of Vascular and Endovascular Surgery, Wake Forest University School of Medicine, Winston-Salem, NC
LF

Lydia L. Faber

Medical Student
Department of Vascular and Endovascular Surgery, Wake Forest University School of Medicine, Winston-Salem, NC
Winston-Salem, North Carolina
KD

Kameron T. Downs

Medical Student
Department of Vascular and Endovascular Surgery, Wake Forest University School of Medicine, Winston-Salem, NC
ND

Noah E. DiNapoli

Medical Student
Department of Vascular and Endovascular Surgery, Wake Forest University School of Medicine, Winston-Salem, NC
AS

Ashlee E. Stutsrim

Assistant Professor
Department of Vascular and Endovascular Surgery, Wake Forest University School of Medicine, Winston-Salem, NC
JH

Justin B. Hurie

Associate Professor
Department of Vascular and Endovascular Surgery, Wake Forest University School of Medicine, Winston-Salem, NC
Winston-Salem, North Carolina
BM

Buddy Marterre

Assistant Professor
Department of General Surgery & Department of Internal Medicine Section on Gerontology and Geriatric Medicine (Palliative Medicine), Wake Forest University School of Medicine, Winston-Salem, NC
JB

Justin K. Brooten

Assistant Professor
Department of Emergency Medicine & Department of Internal Medicine Section on Gerontology and Geriatric Medicine (Palliative Medicine), Wake Forest University School of Medicine, Winston-Salem, NC

Senior Author(s)

Gabriela Velazquez, MD (she/her/hers)

Associate Professor
Department of Vascular and Endovascular Surgery, Wake Forest University School of Medicine, Winston-Salem, NC
Winston-Salem, North Carolina

Objectives: Palliative care (PC) has been shown to improve end-of-life outcomes among vascular surgery patients. The exact criteria for PC consultation remains unclear, however frailty is a key determinant. This study was designed to evaluate the current utilization of PC consultations for vascular surgery patients at our institution. We hypothesized that automated frailty scores would be a predictor of early mortality among patients receiving PC consultations.

Methods: We retrospectively reviewed admissions to a vascular surgery service who received an initial PC consultation between January 2020 and July 2023. Data collected included demographics, comorbidities, vascular diagnosis, surgical history, electronic frailty index (eFI) score, and indications for consultation. Patients with eFI scores were categorized as fit (eFI ≤ 0.1), prefrail (0.10 < eFI ≤ 0.21), or frail (eFI > 0.21). Outcomes included length of hospital stay, admission complications, discharge location, 30-day readmission, and mortality.

Results: 54 identified patients received an initial PC consultation. Patients were mostly white (80%) and insured by Medicare (74%), with a mean age of 71.1 years (Table I). On average, patients presented 3.9 years after earliest documentation of primary vascular diagnosis and with a history of 2 vascular operations. 22 (41%) patients presented acutely without prior related vascular history. During admission, 16 (30%) patients were deemed non-operative candidates. eFI scores were available for 27 patients: 3 fit, 9 prefrail, and 15 frail. Indications for consultation included goals of care (89%), transition of care (33%), psychosocial support (26%), pain management (13%), and non-pain symptom management (4%). For the entire cohort, mean hospital length of stay was 9.6 days with 15 (28%) patients expiring in-hospital, 16 (30%) discharged to hospice, and 13 (24%) discharged to acute care facility (Table II). Admission complications included myocardial infarction (13%), acute kidney injury (50%), stroke (7%), respiratory failure (46%), systemic infection (33%), and return to OR (30%). 5 (9%) patients were readmitted within 30 days of discharge. Overall 30-day and 6-month mortality was 57% and 72% respectively with no significant differences between frailty categories.

Conclusions: Most common indication for PC consultation was goals of care discussions. Among patients with frailty scores, a large proportion were frail or prefrail. Survival analysis showed more decline in frail patients. Death at later intervals may reflect increased baseline risk of 6-month death. Patients with inadequate data to generate frailty scores did worse, potentially from prior lack of healthcare utilization. When available, frailty scores may provide benefit in decision making regarding PC consultations.