Citation

Lilley EJ, Lee KC, Scott JW, Krumrei NJ, Haider AH, Salim A, Gupta R, Cooper Z. J. Trauma Acute Care Surg. 2018; 85(5): 992-998.

Affiliation

Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA Department of Surgery, University of California San Diego, La Jolla, CA Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA Department of Surgery, Brigham and Women's Hospital, Boston, MA Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA Division of Trauma, Burn, and Surgical Critical Care, Brigham & Women's Hospital, Boston, MA Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA Division of Trauma, Burn, and Surgical Critical Care, Brigham & Women's Hospital, Boston, MA Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA Division of Trauma, Burn, and Surgical Critical Care, Brigham & Women's Hospital, Boston, MA.

Copyright

(Copyright © 2018, Lippincott Williams and Wilkins)

DOI

10.1097/TA.0000000000002000

PMID

29851910

Abstract

BACKGROUND: Palliative care is associated with lower intensity treatment and better outcomes at the end of life. Trauma surgeons play a critical role in end-of-life (EOL) care, however the impact of PC on healthcare utilization at the end of life has yet to be characterized in older trauma patients.

METHODS: This retrospective cohort study using 2006-2011 national Medicare claims included trauma patients ≥65 years who died within 180 days after discharge. The exposure of interest was inpatient palliative care during the trauma admission. A non-PC control group was developed by exact-matching for age, comorbidity, admission year, injury severity, length of stay, and post-discharge survival. We employed logistic regression to evaluate six EOL care outcomes: discharge to hospice, rehospitalization, skilled nursing facility (SNF) or long-term acute care hospital (LTACH) admission, death in an institutional setting, and intensive care unit (ICU) admission or receipt of life-sustaining treatments (LST) during a subsequent hospitalization.

RESULTS: Of 294,665 patients who died within 180 days after discharge, 2.1% received inpatient PC. Among 5,693 matched pairs, inpatient PC was associated with increased odds of discharge to hospice (odds ratio [95% confidence interval] = 3.80 [3.54-4.09]) and reduced odds of rehospitalization (0.17[0.15-0.20]), SNF/LTACH admission (0.43[0.39-0.47]), death in an institutional setting (0.34[0.30-0.39]), subsequent ICU admission (0.51[0.36-0.72]), or receiving LST (0.56[0.39-0.80]).

CONCLUSIONS: Inpatient palliative care is associated with lower intensity and less burdensome EOL care in the geriatric trauma population. Nonetheless, it remains underutilized among those who die within 6 months after discharge. LEVEL OF EVIDENCE: Level III STUDY TYPE: Prognostic.

Language: en