title: Utility of the "Surprise" Question in Predicting Survival among Older Patients with Acute Surgical Conditions.
abstract: The surprise question is a validated tool for identifying patients with increased risk of death within one year who could, therefore, benefit from palliative care. However, its utility in surgery is unknown.
  
  
  
  We sought to determine whether the surprise question predicted 12-month mortality in older emergency general surgery patients.
  
  
  
  This was a prospective cohort study.
  
  
  
  Emergency general surgery attendings and surgical residents in or beyond their third year of training at a single tertiary care academic hospital from January to July 2014.
  
  
  
  Surgeons responded to the surprise question within 72 hours of evaluating patients, ≥65 years, hospitalized with an acute surgical condition. Patient data, including demographic and clinical characteristics, were extracted from the medical record. Mortality within 12 months of initial evaluation was determined by using Social Security death data.
  
  
  
  Ten attending surgeons and 18 surgical residents provided 163 responses to the surprise question for 119 patients: 60% of responses were "No, I would not be surprised" and 40% were "Yes, I would be surprised." A "No" response was associated with increased odds of death within 12 months in binary logistic regression (OR 4.8 [95% CI 2.1-11.1]).
  
  
  
  The surprise question is a valuable tool for identifying older patients with higher risk of death, and it may be a useful screening criterion for older emergency general surgery patients who would benefit from palliative care evaluation.
authors: 1 Center for Surgery and Public Health, Brigham and Women's Hospital , Boston, Massachusetts.|2 Department of Surgery, Rutgers-Robert Wood Johnson Medical School , New Brunswick, New Jersey.
authors: Elizabeth J
authors: EJ
authors: Lilley
authors: 3 Surgical ICU Translational Research (STAR) Center , Brigham and Women's Hospital, Boston, Massachusetts.
authors: Sean A
authors: SA
authors: Gemunden
authors: 4 Department of Surgery, Newton-Wellesley Hospital , Newton, Massachusetts.
authors: Gentian
authors: G
authors: Kristo
authors: 1 Center for Surgery and Public Health, Brigham and Women's Hospital , Boston, Massachusetts.|5 Department of Surgery, Howard University College of Medicine , Washington, DC.
authors: Navin
authors: N
authors: Changoor
authors: 1 Center for Surgery and Public Health, Brigham and Women's Hospital , Boston, Massachusetts.|6 Department of Surgery, Harvard Medical School, Brigham and Women's Hospital , Boston, Massachusetts.
authors: John W
authors: JW
authors: Scott
authors: 7 Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital , Boston, Massachusetts.|8 Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute , Boston, Massachusetts.
authors: Elizabeth
authors: E
authors: Rickerson
authors: 6 Department of Surgery, Harvard Medical School, Brigham and Women's Hospital , Boston, Massachusetts.
authors: Naomi
authors: N
authors: Shimizu
authors: 1 Center for Surgery and Public Health, Brigham and Women's Hospital , Boston, Massachusetts.|3 Surgical ICU Translational Research (STAR) Center , Brigham and Women's Hospital, Boston, Massachusetts.|6 Department of Surgery, Harvard Medical School, Brigham and Women's Hospital , Boston, Massachusetts.
authors: Ali
authors: A
authors: Salim
authors: 1 Center for Surgery and Public Health, Brigham and Women's Hospital , Boston, Massachusetts.|3 Surgical ICU Translational Research (STAR) Center , Brigham and Women's Hospital, Boston, Massachusetts.|6 Department of Surgery, Harvard Medical School, Brigham and Women's Hospital , Boston, Massachusetts.
authors: Zara
authors: Z
authors: Cooper
mesh_terms: D000208:Acute Disease; D000368:Aged; D004638:Emergency Treatment / Q000379:methods / Q000401:mortality / Q000592:standards*; D005260:Female; D013502:General Surgery / Q000379:methods / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D010166:Palliative Care / Q000379:methods / Q000592:standards*; D011379:Prognosis; D011446:Prospective Studies; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods; D012720:Severity of Illness Index; D016019:Survival Analysis
keywords: geriatric surgery; prognostication; surgery