Maine Medical Center, Medical Education, Maine Medical Center Research Institute, Palliative Care
Elective Surgical Procedures
Background: In 2010, 19.2 million procedures were performed in patients greater than 65 years of age. Older adults are more likely to be frail and have a greater burden of comorbid illness resulting in an increased risk of postoperative complications. Given the risk of post-operative events, it is especially important to understand the patient’s individual values to ensure goal-concordant medical care. The American College of Surgeons and the American Geriatric Society have jointly recommended advance care planning for all older adults undergoing surgery. Despite this, prior studies indicate that as many as half of older patients did not have an advanced. Studies have shown that while surgeons may discuss preferences regarding CPR, completion of advance care planning documents is rarely encouraged. We sought to understand how many older patients have advance directives completed prior to surgery at Maine Medical Center and the patient characteristics associated with completion of advance care planning.
Approach: We performed a retrospective cross-sectional analysis of all patients greater than 65 years of age seen by an Internal Medicine physician at the Pre-operative Readiness Education Program (PREP) clinic from July 2017 to July 2019. This population was chosen to best understand current clinical practices in a high-risk population. We extracted patient characteristics including their demographics, advanced directive status and details, functional status, severity of illness, risk of mortality. We also extracted information on the post-operative course including length of stay, disposition, palliative medicine consultation, and rate of surgical complications through the Clavien-Dindo score. We will analyze this data using SAS to characterize the patient population and compare those patients who completed advance directives with those who did not.
Results: We identified 495 patients over the age of 65 who underwent elective surgery and were seen in the MMC PREP clinic. Chart extraction has been completed and final analysis will be presented at the Costas T. Lambrew Retreat We plan to compare those patients who completed advance directives prior to surgery to those who did not. These results will help us to understand how current care at MMC compares to guidelines and be used to guide future interventions.
Honeyman, Brian; Kalman, Rebecca; and Hutchinson, Rebecca, "The State of Advanced Care Planning in Older Adults undergoing Elective Surgery at MMC" (2020). Costas T. Lambrew Research Retreat 2020. 82.