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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

a Percentage of clinical specialties of palliative patients relative to the total number of palliative patients. (Other = clinical specialties with less than 5 palliative patients). b Percentage of palliative patients of a clinical specialty relative to the total number of patients under anaesthesiological care of that clinical specialty. (Other = clinical specialties with less than 5 palliative patients)
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Fig2: a Percentage of clinical specialties of palliative patients relative to the total number of palliative patients. (Other = clinical specialties with less than 5 palliative patients). b Percentage of palliative patients of a clinical specialty relative to the total number of patients under anaesthesiological care of that clinical specialty. (Other = clinical specialties with less than 5 palliative patients)

Mentions: Of the 17,304 non-palliative patients, 12,621 (72.9 % vs. 60.9 % in palliative patients) were elective, 1,870 (10.8 % vs. 17.4 %) were urgent, and 2,813 (16.3 % vs. 21.7 %) were emergency cases (P < 0.001). Most procedures in palliative patients were directly related to the life-limiting disease; only 3.3 % had other reasons (e.g. myringotomy in a patient with otitis media, axillary-femoral bypass in a patient with lower limb ischemia). A substantial amount of palliative patients were treated after the regular working hours (7 a.m. to 4 p.m.) or on weekends (30.4 %). Palliative patients were rarely identified as palliative by the anaesthesiologist, who conducted the preprocedural interview and filled out the anaesthesia record (4.2 %). A do-not-resuscitate order was mentioned on only two anaesthesia records (0.7 %). Most palliative patients were treated by general surgery (29.7 %), internal medicine (24.6 %), and head and neck surgery (18.1 %) (Fig. 2a). In regard to the total number of patients under anaesthesiological care from one specialty (Fig. 2b), the highest rates of palliative patients were in radiation therapy (8.0 %), thoracic surgery (7.4 %), and internal medicine (6.1 %). Since receiving or being in need of a specific palliative therapy to alleviate symptoms was one of the criteria to define a patient as a palliative patient, all patients showed at least one symptom (range 1–6), with pain being the most prevalent symptom followed by gastrointestinal symptoms and nutritional problems (Table 4). 11.6 % of the palliative patients were seen by our hospital’s palliative care consultation service during their hospital stay, with 2.2 % being seen preprocedural.Fig. 2


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)

a Percentage of clinical specialties of palliative patients relative to the total number of palliative patients. (Other = clinical specialties with less than 5 palliative patients). b Percentage of palliative patients of a clinical specialty relative to the total number of patients under anaesthesiological care of that clinical specialty. (Other = clinical specialties with less than 5 palliative patients)
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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

Fig2: a Percentage of clinical specialties of palliative patients relative to the total number of palliative patients. (Other = clinical specialties with less than 5 palliative patients). b Percentage of palliative patients of a clinical specialty relative to the total number of patients under anaesthesiological care of that clinical specialty. (Other = clinical specialties with less than 5 palliative patients)
Mentions: Of the 17,304 non-palliative patients, 12,621 (72.9 % vs. 60.9 % in palliative patients) were elective, 1,870 (10.8 % vs. 17.4 %) were urgent, and 2,813 (16.3 % vs. 21.7 %) were emergency cases (P < 0.001). Most procedures in palliative patients were directly related to the life-limiting disease; only 3.3 % had other reasons (e.g. myringotomy in a patient with otitis media, axillary-femoral bypass in a patient with lower limb ischemia). A substantial amount of palliative patients were treated after the regular working hours (7 a.m. to 4 p.m.) or on weekends (30.4 %). Palliative patients were rarely identified as palliative by the anaesthesiologist, who conducted the preprocedural interview and filled out the anaesthesia record (4.2 %). A do-not-resuscitate order was mentioned on only two anaesthesia records (0.7 %). Most palliative patients were treated by general surgery (29.7 %), internal medicine (24.6 %), and head and neck surgery (18.1 %) (Fig. 2a). In regard to the total number of patients under anaesthesiological care from one specialty (Fig. 2b), the highest rates of palliative patients were in radiation therapy (8.0 %), thoracic surgery (7.4 %), and internal medicine (6.1 %). Since receiving or being in need of a specific palliative therapy to alleviate symptoms was one of the criteria to define a patient as a palliative patient, all patients showed at least one symptom (range 1–6), with pain being the most prevalent symptom followed by gastrointestinal symptoms and nutritional problems (Table 4). 11.6 % of the palliative patients were seen by our hospital’s palliative care consultation service during their hospital stay, with 2.2 % being seen preprocedural.Fig. 2

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