Article Text
Abstract
Objectives Palliative surgery aims to relieve patients’ symptoms and improve quality of life with surgical interventions. While a multidisciplinary approach has been found beneficial for critically ill patients, limited evidence supports this approach in palliative surgery. Here we sought to study whether palliative care consultations can improve outcomes among patients undergoing palliative surgery.
Methods Consecutive patients undergoing palliative care at gastrosurgical wards in a tertiary Finnish university hospital during a 2-year study period were included. Outcomes of those undergoing surgery with or without palliative care consultation were compared. The main outcome measures were patients’ functional status, postoperative morbidity and mortality.
Results A total of 312 patients were included, of whom 173 underwent surgery, 77 endoscopic care and 62 were treated conservatively. Of the operated patients, 24 underwent multidisciplinary assessment while among the rest, the treatment decision was based on the surgeons’ assessment. Multidisciplinary assessment was associated with a clinically significantly reduced morbidity (8.3% vs 23%, p=0.111), in-hospital mortality (8.3% vs 17%, p=0.051) and rate of hospital readmissions (8.3% vs 21%, p=0.052). There was no difference in median survival 49 (2–440) vs 45 (1–971) days (p=0.949). Of those undergoing conservative care, 44% could have undergone surgery.
Conclusions The aim of the palliative surgery is to relieve symptoms among patients with no hope of being cured. While the involvement of the palliative care consultation into the surgical decision-making is likely to reduce unnecessary operations, it is likely to be even more important in improving quality of end-of-life care.
- Gastrointestinal (lower)
- Gastrointestinal (upper)
- Pancreatic
- End of life care
- Supportive care
Data availability statement
All data relevant to the study are included in the article.
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Data availability statement
All data relevant to the study are included in the article.
Footnotes
Contributors ML—planning the research, data collection, data analysis, drafting and writing the article and approval of the final version of article. RPP—planning the research, critical revision and final approval of the article. JL—planning the research, critical revision and final approval of the article. MU—planning the research, data analysis, drafting the article and final approval of the article. All authors of the article take full responsibility for the completed article and the publication decision. MU is responsible for the overall content as the guarantor.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; internally peer reviewed.