Patterns of Care in Hospitalized Vascular Surgery Patients at End of Life.
There is limited literature reporting circumstances surrounding end-of-life care in vascular surgery patients.



To identify factors driving end-of-life decisions in vascular surgery patients.



In this cohort study, medical records were reviewed for all vascular surgery patients at a tertiary care university hospital who died during their hospitalization from 2005 to 2014.



Patient, family, and hospitalization variables potentially important to influencing end-of-life decisions.



Of 111 patients included (67 [60%] male; median age, 75 [range, 24-94] years), 81 (73%) were emergent vs 30 (27%) elective admissions. Only 15 (14%) had an advance directive. Of the 81 (73%) patients placed on comfort care, 31 (38%) had care withheld or withdrawn despite available medical options, 15 (19%) had an advance directive, and 28 (25%) had a palliative care consultation. The median time from palliative care consultation to death was 10 hours (interquartile range, 3.36-66 hours). Comparing the 31 patients placed on comfort care despite available medical options with an admission diagnosis-matched cohort, we found that more than 5 days admitted to the intensive care unit (odds ratio [OR], 4.11; 95% CI, 1.59-10.68; P < .001), more than 5 days requiring ventilator support (OR, 9.45; 95% CI, 3.41-26.18; P < .001), new renal failure necessitating dialysis (OR, 14.48; 95% CI, 3.69-56.86; P < .001), and new respiratory failure necessitating tracheostomy (OR, 23.92; 95% CI, 2.80-204; P < .001) correlated with transition to comfort care.



Palliative care consultations may be underused at the end of life. A large percentage of patients were transitioned to comfort measures despite available treatment, yet few presented with advance directives. In high-risk patients, discussions regarding extended stays in the intensive care unit, prolonged ventilator management, and possible dialysis and tracheostomy should be communicated with patients and families at time of hospitalization and advance directives solicited.
Division of Vascular Surgery, Department of Surgery, Knight Cardiovascular Institute, Oregon Health and Science University, Portland.
Dale G
DG
Wilson
Division of Vascular Surgery, Department of Surgery, Knight Cardiovascular Institute, Oregon Health and Science University, Portland.
Sheena K
SK
Harris
Decedent Affairs, Oregon Health and Science University, Portland.
Heidi
H
Peck
Division of Vascular Surgery, Department of Surgery, Knight Cardiovascular Institute, Oregon Health and Science University, Portland.
Kyle
K
Hart
Division of Vascular Surgery, Department of Surgery, Knight Cardiovascular Institute, Oregon Health and Science University, Portland.
Enjae
E
Jung
Division of Vascular Surgery, Department of Surgery, Knight Cardiovascular Institute, Oregon Health and Science University, Portland.
Amir F
AF
Azarbal
Division of Vascular Surgery, Department of Surgery, Knight Cardiovascular Institute, Oregon Health and Science University, Portland.
Erica L
EL
Mitchell
Division of Vascular Surgery, Department of Surgery, Knight Cardiovascular Institute, Oregon Health and Science University, Portland.
Gregory J
GJ
Landry
Division of Vascular Surgery, Department of Surgery, Knight Cardiovascular Institute, Oregon Health and Science University, Portland.
Gregory L
GL
Moneta
D000328:Adult; D016223:Advance Directives / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D000066491:Clinical Decision-Making; D005260:Female; D006760:Hospitalization; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000706:statistics & numerical data*; D000070659:Patient Comfort / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D006435:Renal Dialysis; D051437:Renal Insufficiency / Q000628:therapy; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000601:surgery; D012189:Retrospective Studies; D013727:Terminal Care; D014139:Tracheostomy; D014656:Vascular Surgical Procedures / Q000706:statistics & numerical data*; D028761:Withholding Treatment / Q000706:statistics & numerical data; D055815:Young Adult