Skip to main content
Top
Published in: BMC Anesthesiology 1/2015

Open Access 01-12-2015 | Research article

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

Authors: Christoph L. Lassen, Susanne Aberle, Nicole Lindenberg, Annika Bundscherer, Tobias W. Klier, Bernhard M. Graf, Christoph H. Wiese

Published in: BMC Anesthesiology | Issue 1/2015

Login to get access

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.
Literature
1.
go back to reference Fine PG. The evolving and important role of anesthesiology in palliative care. Anesth Analg. 2005;100(1):183–8.CrossRefPubMed Fine PG. The evolving and important role of anesthesiology in palliative care. Anesth Analg. 2005;100(1):183–8.CrossRefPubMed
2.
go back to reference Kettler D, Nauck F. Palliative care and involvement of anaesthesiology: current discussions. Curr Opin Anaesthesiol. 2010;23(2):173–6.CrossRefPubMed Kettler D, Nauck F. Palliative care and involvement of anaesthesiology: current discussions. Curr Opin Anaesthesiol. 2010;23(2):173–6.CrossRefPubMed
3.
go back to reference Hua MS, Li G, Blinderman CD, Wunsch H. Estimates of the need for palliative care consultation across united states intensive care units using a trigger-based model. Am J Respir Crit Care Med. 2014;189(4):428–36.CrossRefPubMedPubMedCentral Hua MS, Li G, Blinderman CD, Wunsch H. Estimates of the need for palliative care consultation across united states intensive care units using a trigger-based model. Am J Respir Crit Care Med. 2014;189(4):428–36.CrossRefPubMedPubMedCentral
4.
go back to reference Mercadante S, Villari P, Ferrera P. A model of acute symptom control unit: pain relief and palliative care unit of La Maddalena Cancer Center. Support Care Cancer. 2003;11(2):114–9.PubMed Mercadante S, Villari P, Ferrera P. A model of acute symptom control unit: pain relief and palliative care unit of La Maddalena Cancer Center. Support Care Cancer. 2003;11(2):114–9.PubMed
5.
go back to reference Wiese CH, Bartels UE, Ruppert D, Marung H, Luiz T, Graf BM, et al. Treatment of palliative care emergencies by prehospital emergency physicians in Germany: an interview based investigation. Palliat Med. 2009;23(4):369–73.CrossRefPubMed Wiese CH, Bartels UE, Ruppert D, Marung H, Luiz T, Graf BM, et al. Treatment of palliative care emergencies by prehospital emergency physicians in Germany: an interview based investigation. Palliat Med. 2009;23(4):369–73.CrossRefPubMed
6.
go back to reference Badgwell BD, Aloia TA, Garrett J, Chedister G, Miner T, Krouse R. Indicators of symptom improvement and survival in inpatients with advanced cancer undergoing palliative surgical consultation. J Surg Oncol. 2013;107(4):367–71.CrossRefPubMed Badgwell BD, Aloia TA, Garrett J, Chedister G, Miner T, Krouse R. Indicators of symptom improvement and survival in inpatients with advanced cancer undergoing palliative surgical consultation. J Surg Oncol. 2013;107(4):367–71.CrossRefPubMed
7.
go back to reference Kucukmetin A, Naik R, Galaal K, Bryant A, Dickinson HO. Palliative surgery versus medical management for bowel obstruction in ovarian cancer. Cochrane Database Syst Rev. 2010;7:CD007792.PubMed Kucukmetin A, Naik R, Galaal K, Bryant A, Dickinson HO. Palliative surgery versus medical management for bowel obstruction in ovarian cancer. Cochrane Database Syst Rev. 2010;7:CD007792.PubMed
8.
go back to reference Burkle CM, Swetz KM, Armstrong MH, Keegan MT. Patient and doctor attitudes and beliefs concerning perioperative do not resuscitate orders: anesthesiologists’ growing compliance with patient autonomy and self determination guidelines. BMC Anesthesiol. 2013;13:2.CrossRefPubMedPubMedCentral Burkle CM, Swetz KM, Armstrong MH, Keegan MT. Patient and doctor attitudes and beliefs concerning perioperative do not resuscitate orders: anesthesiologists’ growing compliance with patient autonomy and self determination guidelines. BMC Anesthesiol. 2013;13:2.CrossRefPubMedPubMedCentral
9.
go back to reference Truog RD, Waisel DB, Burns JP. DNR in the OR: a goal-directed approach. Anesthesiology. 1999;90(1):289–95.CrossRefPubMed Truog RD, Waisel DB, Burns JP. DNR in the OR: a goal-directed approach. Anesthesiology. 1999;90(1):289–95.CrossRefPubMed
10.
go back to reference Scott TH, Gavrin JR. Palliative surgery in the do-not-resuscitate patient: ethics and practical suggestions for management. Anesthesiol Clin. 2012;30(1):1–12.CrossRefPubMed Scott TH, Gavrin JR. Palliative surgery in the do-not-resuscitate patient: ethics and practical suggestions for management. Anesthesiol Clin. 2012;30(1):1–12.CrossRefPubMed
11.
go back to reference Krouse RS, Nelson RA, Farrell BR, Grube B, Juarez G, Wagman LD, et al. Surgical palliation at a cancer center: incidence and outcomes. Arch Surg. 2001;136(7):773–8.CrossRefPubMed Krouse RS, Nelson RA, Farrell BR, Grube B, Juarez G, Wagman LD, et al. Surgical palliation at a cancer center: incidence and outcomes. Arch Surg. 2001;136(7):773–8.CrossRefPubMed
12.
go back to reference Miner TJ, Brennan MF, Jaques DP. A prospective, symptom related, outcomes analysis of 1022 palliative procedures for advanced cancer. Ann Surg. 2004;240(4):719–26. discussion 726–717.PubMedPubMedCentral Miner TJ, Brennan MF, Jaques DP. A prospective, symptom related, outcomes analysis of 1022 palliative procedures for advanced cancer. Ann Surg. 2004;240(4):719–26. discussion 726–717.PubMedPubMedCentral
13.
go back to reference Van Mechelen W, Aertgeerts B, De Ceulaer K, Thoonsen B, Vermandere M, Warmenhoven F, et al. Defining the palliative care patient: a systematic review. Palliat Med. 2013;27(3):197–208.CrossRefPubMed Van Mechelen W, Aertgeerts B, De Ceulaer K, Thoonsen B, Vermandere M, Warmenhoven F, et al. Defining the palliative care patient: a systematic review. Palliat Med. 2013;27(3):197–208.CrossRefPubMed
14.
go back to reference Sepulveda C, Marlin A, Yoshida T, Ullrich A. Palliative care: the World Health Organization’s global perspective. J Pain Symptom Manage. 2002;24(2):91–6.CrossRefPubMed Sepulveda C, Marlin A, Yoshida T, Ullrich A. Palliative care: the World Health Organization’s global perspective. J Pain Symptom Manage. 2002;24(2):91–6.CrossRefPubMed
15.
go back to reference Badgwell BD, Smith K, Liu P, Bruera E, Curley SA, Cormier JN. Indicators of surgery and survival in oncology inpatients requiring surgical evaluation for palliation. Support Care Cancer. 2009;17(6):727–34.CrossRefPubMed Badgwell BD, Smith K, Liu P, Bruera E, Curley SA, Cormier JN. Indicators of surgery and survival in oncology inpatients requiring surgical evaluation for palliation. Support Care Cancer. 2009;17(6):727–34.CrossRefPubMed
16.
go back to reference Adolph MD. Inpatient palliative care consultation: enhancing quality of care for surgical patients by collaboration. Surg Clin North Am. 2011;91(2):317–24. viii.CrossRefPubMed Adolph MD. Inpatient palliative care consultation: enhancing quality of care for surgical patients by collaboration. Surg Clin North Am. 2011;91(2):317–24. viii.CrossRefPubMed
17.
go back to reference Zimmermann C, Swami N, Krzyzanowska M, Hannon B, Leighl N, Oza A, et al. Early palliative care for patients with advanced cancer: a cluster-randomised controlled trial. Lancet. 2014;383(9930):1721–30.CrossRefPubMed Zimmermann C, Swami N, Krzyzanowska M, Hannon B, Leighl N, Oza A, et al. Early palliative care for patients with advanced cancer: a cluster-randomised controlled trial. Lancet. 2014;383(9930):1721–30.CrossRefPubMed
18.
go back to reference Kwok AC, Semel ME, Lipsitz SR, Bader AM, Barnato AE, Gawande AA, et al. The intensity and variation of surgical care at the end of life: a retrospective cohort study. Lancet. 2011;378(9800):1408–13.CrossRefPubMed Kwok AC, Semel ME, Lipsitz SR, Bader AM, Barnato AE, Gawande AA, et al. The intensity and variation of surgical care at the end of life: a retrospective cohort study. Lancet. 2011;378(9800):1408–13.CrossRefPubMed
19.
go back to reference Barnet CS, Arriaga AF, Hepner DL, Correll DJ, Gawande AA, Bader AM. Surgery at the end of life: a pilot study comparing decedents and survivors at a tertiary care center. Anesthesiology. 2013;119(4):796–801.CrossRefPubMed Barnet CS, Arriaga AF, Hepner DL, Correll DJ, Gawande AA, Bader AM. Surgery at the end of life: a pilot study comparing decedents and survivors at a tertiary care center. Anesthesiology. 2013;119(4):796–801.CrossRefPubMed
20.
go back to reference Kwok AC, Hu YY, Dodgion CM, Jiang W, Ting GV, Taback N, et al. Invasive procedures in the elderly after stage IV cancer diagnosis. J Surg Res. 2015;193(2):754–63.CrossRefPubMed Kwok AC, Hu YY, Dodgion CM, Jiang W, Ting GV, Taback N, et al. Invasive procedures in the elderly after stage IV cancer diagnosis. J Surg Res. 2015;193(2):754–63.CrossRefPubMed
21.
go back to reference van Oorschot B, Schuler M, Simon A, Flentje M. Advance directives: prevalence and attitudes of cancer patients receiving radiotherapy. Support Care Cancer. 2012;20(11):2729–36.CrossRefPubMed van Oorschot B, Schuler M, Simon A, Flentje M. Advance directives: prevalence and attitudes of cancer patients receiving radiotherapy. Support Care Cancer. 2012;20(11):2729–36.CrossRefPubMed
Metadata
Title
Palliative patients under anaesthesiological care: a single-centre retrospective study on incidence, demographics and outcome
Authors
Christoph L. Lassen
Susanne Aberle
Nicole Lindenberg
Annika Bundscherer
Tobias W. Klier
Bernhard M. Graf
Christoph H. Wiese
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Anesthesiology / Issue 1/2015
Electronic ISSN: 1471-2253
DOI
https://doi.org/10.1186/s12871-015-0143-4

Other articles of this Issue 1/2015

BMC Anesthesiology 1/2015 Go to the issue