Setting Trends in the Preoperative Care Setting: Advance Care Planning (SA510A)

Abstract

•Examine the prevalence of Advance Directives in patients undergoing elective surgery.•Analyze the relationship between risk factors for postoperative complications and readmissions with the completion and availability of advanced directives.•Identify the relationship between risk factors preoperatively and outcomes postoperatively to develop protocols for a collaborative, interdisciplinary partnership for increased completion of Advance Directives. High-risk patients undergoing elective surgery have an increased likelihood of life-threatening complications.1-5 Most lack capacity during their procedure, yet completion of Advance Directives (ADs) is not required.6 The Objectives of this project were: 1) identify the prevalence of ADs (living will or surrogate decision maker) and 2) assess for relationship between ADs, preoperative risk factors, readmissions, and mortality. This was a retrospective chart review of patients undergoing preoperative evaluation for elective surgery. Demographic, comorbidities, Charlson Index Reviewed, Revised Cardiac Risk Index, and functional status were obtained from the preoperative evaluation. The Electronic Medical Record (EMR) was reviewed for the presence of AD’s prior to surgery and at 1-year follow-up, 1-year mortality, and readmissions. Statistical methods included chi-square, Fisher’s exact, and multiple logistic regression. Four hundred charts were reviewed. Thirty-five percent of patients were ≥65 years old and 29% reported having an AD; however, only 12.5% had an AD in the EMR prior to surgery. In the regression model, age ≥65, male gender, congestive heart failure, and HIV/AIDS were associated with having an AD on file (p-values <0.05). Of 386 records at 1-year follow-up, 18 were deceased, of which 3 (17%) had completed an AD prior to surgery. One-hundred two patients were readmitted at least once. Readmissions were not related with having an AD on file at 1 year (p-value 0.42). Less than 15% of patients undergoing elective surgery had ADs on file. Patients who were readmitted were not more likely to have an AD. Preoperative clinics provide an opportunity to identify and assist with advance care planning.