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Palliative patients under anaesthesiological care: a single-centre retrospective study on incidence, demographics and outcome.

Lassen CL, Aberle S, Lindenberg N, Bundscherer A, Klier TW, Graf BM, Wiese CH - BMC Anesthesiol (2015)

Bottom Line: In comparison to the non-palliative patients, procedures in palliative patients were significantly more often urgent or emergency procedures (39.1 % vs. 27.1 %., P < 0.001), and hospital mortality was higher (18.8 % vs. 5.0 %, P < 0.001).Palliative patients are treated by anesthesiologists under varying circumstances.Anesthesiologists need to identify these patients and need to be aware of their characteristics to adequately attend to them during the periprocedural period.

View Article: PubMed Central - PubMed

Affiliation: Department of Anaesthesiology, University Hospital of Regensburg, Franz-Josef-Strauss-Allee 11, D-93053, Regensburg, Germany. christoph.lassen@ukr.de.

ABSTRACT

Background: While anesthesiologist's involvement in palliative care has been widely researched, extensive data on palliative patients under anesthesiological care in the operating room is missing. This study was performed to assess the incidence, demographics, and outcome of palliative patients under anesthesiological care.

Methods: We conducted a single-center retrospective chart review of all palliative patients under anesthesiological care at a university hospital in 1 year. Patients were classified as palliative if they fulfilled all predefined criteria (a) incurable, life-threatening disease, (b) progression of the disease despite therapy, (c) advanced stage of the disease with limited life-expectancy, (d) receiving or being in need of a specific palliative therapy. Demographics, periprocedural parameters, symptoms at evaluation, and outcome were determined using different medical records.

Results: Of 17,580 patients examined, 276 could be classified as palliative patients (1.57 %). Most contacts with palliative patients occurred in the operating room (68.5 %). In comparison to the non-palliative patients, procedures in palliative patients were significantly more often urgent or emergency procedures (39.1 % vs. 27.1 %., P < 0.001), and hospital mortality was higher (18.8 % vs. 5.0 %, P < 0.001). Preprocedural symptoms varied, with pain, gastrointestinal, and nutritional problems being the most prevalent.

Conclusions: Palliative patients are treated by anesthesiologists under varying circumstances. Anesthesiologists need to identify these patients and need to be aware of their characteristics to adequately attend to them during the periprocedural period.

No MeSH data available.


Related in: MedlinePlus

Make-up of the study population
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Fig1: Make-up of the study population

Mentions: Of 17,580 patients under anaesthesiological care at our hospital in 2009, 276 could be classified as palliative patients (1.57 %) (Fig. 1). The palliative patients were older, had a higher ASA-classification, showed more often the presence of an oncological disease, and had a higher hospital mortality than the non-palliative patients (Table 2). All these differences were statistically significant (P < 0.001). Concerning the oncological disease, the primary tumor site in most patients was the gastrointestinal tract (27.9 %) followed by the head/neck region (16.6 %) and tumors of the lung (8.7 %). Anaesthesiological and procedural parameters of the palliative patients are shown in Table 3. Most contacts with palliative patients occurred in the operating room (68.5 %). In a total of seven cases palliative patients were treated in a resuscitation situation, since anaesthesiologists lead the cardiac-arrest-teams in our hospital. In comparison to the non-palliative patients, procedures in palliative patients were significantly more often urgent or emergency procedures. Patients undergoing emergency procedures had a significantly higher in-hospital mortality than non-emergency patients (33.3 % vs 14.8 %, P < 0.001) and a significantly higher rate of treatment in the ICU (45.0 % vs. 31.0 %, P = 0.047).Fig. 1


Palliative patients under anaesthesiological care: a single-centre retrospective study on incidence, demographics and outcome.

Lassen CL, Aberle S, Lindenberg N, Bundscherer A, Klier TW, Graf BM, Wiese CH - BMC Anesthesiol (2015)

Make-up of the study population
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4644289&req=5

Fig1: Make-up of the study population
Mentions: Of 17,580 patients under anaesthesiological care at our hospital in 2009, 276 could be classified as palliative patients (1.57 %) (Fig. 1). The palliative patients were older, had a higher ASA-classification, showed more often the presence of an oncological disease, and had a higher hospital mortality than the non-palliative patients (Table 2). All these differences were statistically significant (P < 0.001). Concerning the oncological disease, the primary tumor site in most patients was the gastrointestinal tract (27.9 %) followed by the head/neck region (16.6 %) and tumors of the lung (8.7 %). Anaesthesiological and procedural parameters of the palliative patients are shown in Table 3. Most contacts with palliative patients occurred in the operating room (68.5 %). In a total of seven cases palliative patients were treated in a resuscitation situation, since anaesthesiologists lead the cardiac-arrest-teams in our hospital. In comparison to the non-palliative patients, procedures in palliative patients were significantly more often urgent or emergency procedures. Patients undergoing emergency procedures had a significantly higher in-hospital mortality than non-emergency patients (33.3 % vs 14.8 %, P < 0.001) and a significantly higher rate of treatment in the ICU (45.0 % vs. 31.0 %, P = 0.047).Fig. 1

Bottom Line: In comparison to the non-palliative patients, procedures in palliative patients were significantly more often urgent or emergency procedures (39.1 % vs. 27.1 %., P < 0.001), and hospital mortality was higher (18.8 % vs. 5.0 %, P < 0.001).Palliative patients are treated by anesthesiologists under varying circumstances.Anesthesiologists need to identify these patients and need to be aware of their characteristics to adequately attend to them during the periprocedural period.

View Article: PubMed Central - PubMed

Affiliation: Department of Anaesthesiology, University Hospital of Regensburg, Franz-Josef-Strauss-Allee 11, D-93053, Regensburg, Germany. christoph.lassen@ukr.de.

ABSTRACT

Background: While anesthesiologist's involvement in palliative care has been widely researched, extensive data on palliative patients under anesthesiological care in the operating room is missing. This study was performed to assess the incidence, demographics, and outcome of palliative patients under anesthesiological care.

Methods: We conducted a single-center retrospective chart review of all palliative patients under anesthesiological care at a university hospital in 1 year. Patients were classified as palliative if they fulfilled all predefined criteria (a) incurable, life-threatening disease, (b) progression of the disease despite therapy, (c) advanced stage of the disease with limited life-expectancy, (d) receiving or being in need of a specific palliative therapy. Demographics, periprocedural parameters, symptoms at evaluation, and outcome were determined using different medical records.

Results: Of 17,580 patients examined, 276 could be classified as palliative patients (1.57 %). Most contacts with palliative patients occurred in the operating room (68.5 %). In comparison to the non-palliative patients, procedures in palliative patients were significantly more often urgent or emergency procedures (39.1 % vs. 27.1 %., P < 0.001), and hospital mortality was higher (18.8 % vs. 5.0 %, P < 0.001). Preprocedural symptoms varied, with pain, gastrointestinal, and nutritional problems being the most prevalent.

Conclusions: Palliative patients are treated by anesthesiologists under varying circumstances. Anesthesiologists need to identify these patients and need to be aware of their characteristics to adequately attend to them during the periprocedural period.

No MeSH data available.


Related in: MedlinePlus