More than 70% of patients do not have advance directives prior to surgery
Approximately 71% of patients seen in perioperative testing clinics prior to surgery do not have any advanced care directives in place, according to a study published in the Journal of General Internal Medicine.
“Patients seen in preoperative testing clinics are at an increased risk of surgical complications and most are incapacitated during anesthesia,” Shiplee Sinha, MD, FACP, of the Advanced Scholars Program for Internists in Research and Education, the departments of palliative care in the Academic Health Center, and the division of general internal medicine and geriatrics at the Indiana University School of Medicine, and colleagues wrote. “Advance directives (ADs) are important to guide care in the event of emergencies when patients are unable to speak for themselves.”
Researchers conducted a retrospective electronic medical record (EMR) review to determine the prevalence of ADs in patients undergoing elective surgery. EMR charts were reviewed for 400 patients who underwent perioperative evaluation in a perioperative clinic in one of two high-volume hospitals between February and March 2017.
In addition to ADs, researchers collected patient data on demographic variables, risk for cardiac complications, comorbid conditions and functionality.
Within the cohort, 71% (n = 284) reported having no form of AD in place, and 29% (n = 116) reported having an AD. After reviewing all EMRs, researchers found that only 16% (n = 64) of patients had ADs that were scanned into the EMR.
Among those with an AD scanned into the EMR, 11.8% (n = 43) had a surrogate decision maker and 11.5% (n = 46) had a living will.
Those aged 65 years and older (OR = 2.85; 95% CI, 1.63-4.98) and patients with congestive heart failure (OR = 4.04; 95% CI, 1.55-10.54) were significantly more likely to have an AD scanned in their EMR.
The researchers found no difference in the risks for complications or death between those who did and did not have an AD.
Researchers noted that the findings demonstrate the need for improvement in advanced care planning in perioperative settings.
“Lack of AD documentation places a burden on family members to make decisions on their loved one’s behalf without patient guidance and can lead to care that does not comport with the patient’s preference,” Sinha and colleagues wrote. – by Erin Michael
Disclosures: The authors report no relevant financial disclosures.