Preoperative Advance Care Planning for Older Adults Undergoing Major Abdominal Surgery.
Josh Bleicher, Lauren E McGuire, Riann B Robbins and 5 others
PMID 34047202WHAT IT FOUND
Most older adults undergoing major abdominal surgery had no advance directive available in their medical record, no surrogate decision-maker identified, and no documented goals of care.
Patients who died or had complications were no more likely to have had this planning than those who did well.
Key findings
01Only 36.3% of patients had an advance directive available in the electronic medical record on the day of surgery, despite 70.0% reporting they had one prior.
0278.7% of patients did not have a surrogate decision-maker identified in the electronic medical record before surgery.
03Patients who experienced major surgical complications were no more likely to have had preoperative advance care planning than those who did not.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study relied on electronic documentation as a proxy for actual conversations. A discussion may have occurred but not been recorded. It was conducted at a single institution with a predominantly white, non-Hispanic population, limiting generalizability to more diverse groups. The sample size was too small to detect differences in mortality rates. Postoperative documentation was not reviewed, so only preoperative planning was assessed.
Declared interests
The authors declared no financial or personal conflicts of interest.
The easy way to misread this
Do not assume that a patient reporting they have an advance directive means the surgical team can access it. In this study, nearly half of those who said they had a directive did not have it available in the record on the day of surgery. Also, do not assume high-risk patients receive more planning; those who had complications were no more likely to have documented goals of care than those who did well.