title: An Assessment of the Frequency of Palliative Procedures in Thoracic Surgery.
abstract: OBJECTIVE
  Palliative care is a medical specialty focused on improving the quality of life of patients and their families with life threatening illness by preventing or relieving suffering. An assessment of a thoracic surgery service was performed to identify the scope and frequency of care that was considered palliative and any implications the findings might have on the current thoracic surgery residency curriculum.
  
  
  METHODS
  A retrospective review of a prospectively collected database of general thoracic surgery procedures performed over a 5-year period at a single institution was performed. Procedures considered palliative were reviewed for demographics, diagnoses, palliative prognosis score, treatment, morbidity, operative mortality, and survival. Excluded were referrals from thoracic surgery to other specialties for palliative procedures.
  
  
  RESULTS
  During the study period, 3842 procedures were performed of which 884 (23%) were palliative. Indications included pleural or pericardial effusion or both, dysphagia, hemoptysis, tracheobronchial obstruction, bronchopleural fistula, and tracheoesophageal fistula. The majority was related to a malignancy. Only 127 patients (14%) had a palliative care assessment before thoracic surgery consultation. Mean survival following thoracic surgery intervention was 110 days for patients with malignancy.
  
  
  CONCLUSIONS
  This investigation found that thoracic surgeons commonly care for patients when the intention or indication or both is palliation. Most of these patients have an associated malignancy, a poor performance status and a projected significantly decreased survival compared with the general population. Thoracic surgeons should be familiar with the concepts of palliative care and consideration should be given to expanding exposure to the principles of palliative care in the cardiothoracic residency training curriculum.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, St Vincent Hospital, Indianapolis, Indiana. Electronic address: Richard.Freeman@StVincent.org.
authors.forename: Richard K
authors.initials: RK
authors.lastname: Freeman
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, St Vincent Hospital, Indianapolis, Indiana.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Arevalo
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, St Vincent Hospital, Indianapolis, Indiana.
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Ascioti
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, St Vincent Hospital, Indianapolis, Indiana.
authors.forename: Megan
authors.initials: M
authors.lastname: Dake
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, St Vincent Hospital, Indianapolis, Indiana.
authors.forename: Raja S
authors.initials: RS
authors.lastname: Mahidhara
mesh_terms: D000328:Adult; D003479:Curriculum; D016208:Databases, Factual; D004503:Education, Medical, Graduate / Q000458:organization & administration; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D007396:Internship and Residency / Q000458:organization & administration; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010166:Palliative Care / Q000379:methods / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D015996:Survival Rate; D019616:Thoracic Surgical Procedures / Q000193:education* / Q000379:methods*; D014481:United States
keywords: Medical Knowledge; Patient Care; cardiothoracic curriculum; palliative care; palliative procedures; thorasic surgery palliative