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DOI: 10.1055/s-0042-1750946
End of Life Care and Advance Care Planning for Outpatients with Inoperable Abdominal Aortic Aneurysms—A Retrospective Cohort Study
Background: A significant proportion of abdominal aortic aneurysms (AAAs) are turned down for repair. Studies have shown a high mortality in this patient cohort,1 however, there exist no studies on the palliative care (PC) they receive following discharged from clinic.
Methods: This is a retrospective cohort study of 114/1007(11%) conservatively managed AAA patients referred to the Central Yorkshire Vascular Partnership for intervention between 2017 and 2021. Demographic details, mortality, cause of death and palliative care outcomes were analyzed to examine predictors of PC referral and efficacy of palliative care consultation (PCC).
Results: There was a 3-year mortality rate of 59% and rupture was the reported cause of death in 16% of the decedents. Only 8% of the patients received PC referrals, on average 11 days before death. Older patients were more likely to have a PCCs. Most (54%) decedents died in hospital. Only 6% of conservatively managed patients had a documented preferred place of death. Patients with PCC were more likely to have preferred place of death and care priorities documented.
Conclusion: Only a small proportion of the patients had advanced care planning (ACP) and this was far below National Institute for Health and Care Excellence (NICE) guidance on end-of-life (EoL) care for adults, which would recommend PC in all of these patients.2 It is also far below the level currently offered to oncology patients, despite the 3-year mortality rate being higher than the majority of cancers. Pathways and guidance should be implemented to ensure patients turned down for AAA intervention receive PCC.
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Palliative care outcomes for 114 conservatively managed AAA > 5.5cm comparison by palliative care consultation |
||||
|
PCC (%)n = 9 |
No PCC (%) n = 105 |
OR (95%CI) |
p-Value |
|
|
Documentation of preferred place of care and death |
5 (56) |
3 (3) |
42.5 (7.4–243.5) |
<0.001[a] |
|
No documentation |
4 (44) |
102 (97) |
||
|
Documentation of care priorities |
9 (100) |
42 (40) |
14.8 (1.8–120.5)[b] |
<0.001[c] |
|
No documentation |
0 (0) |
63 (60) |
||
|
Documentation of family involvement in ACP discussions |
9(100) |
22(21) |
36.5 (4.4–300.2)[b] |
<0.001[c] |
|
No documentation |
0 (0) |
83(79) |
||
|
PCC (d) n = 9 |
No PCC (d) n = 105 |
Estimation for difference (95%CI) |
p-Value |
|
|
Days in hospital in last 6 months of life |
34.1 ± 39.5 |
18.74 ± 22.2 |
15.3 (-18.6–49.3) |
0.32 |
|
Days in ICU in last 30 days of life |
0 ± 0 |
0.052 ± 0.32 |
0.0 (0.0–0.0) |
0.65 |
|
PCC (n) n = 9 |
No PCC (n) n = 105 |
Estimation for difference (95%CI) |
p-Value |
|
|
Number of unplanned hospital admissions in last 6 months of life |
1.88 ± 1.56 |
1.71 ± 1.22 |
0.16 (−1.17–1.50) |
0.78 |
Abbreviations: d, days; n, sample number.
aPearson χ 2 test.
bHaldane-Anscombe correction.
cFisher exact test.
dStandard deviation method (Mean ± SD).
References
1. Conway KP, Byrne J, Townsend M, Lane IF. Prognosis of patients turned down for conventional abdominal aortic aneurysm repair in the endovascular and sonographic era: Szilagyi revisited J Vasc Surg 2001;33(4):752–757 10.1067/mva.2001.112800 [published Online First: 2001/04/11] PubMed
2. NICE. End of life care for adults: service delivery. In: Excellence NIoHaC, ed., 2019.
No conflict of interest has been declared by the author(s).
Publication History
Article published online:
10 June 2022
© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)
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