Despite advancements in medical care and surgical techniques, major amputation continues
to be associated with risks for morbidity and mortality. Palliative care programs
may help alleviate symptoms and align patients’ goals and the care they receive with
their treatment plan. Access to specialty palliative medicine among vascular surgery
patients is limited. Here, we aim to describe utilization and impact of formal palliative
care consultation for patients receiving major amputations.
This is a retrospective, secondary data analysis project examining the records of
patients who received major amputations by the vascular surgery team between 2016
and 2021. Demographics, operative, and postoperative outcomes were recorded. The primary
outcome variable was palliative care consultation during index admission (the admission
in which the patient received their first major amputation). Secondary outcomes were
in-hospital mortality and code status at the time of death, if death occurred during
the index admission, location of death, and discharge destination.
The cohort comprised of 292 patients (39% female, 53% Black, mean age 63), who received
a lower extremity major amputation. Most patients (65%) underwent amputation for limb
ischemia. One-year mortality after first major amputation was 29%. Average length
of stay was 20 days. Thirty-five (12%) patients received a palliative care consultation
during the hospitalization in which they received their first major amputation. On
multivariable analysis, patients were more likely to receive a palliative care consult
during their index admission if they had undergone a thorough knee amputation (OR = 2.89,
P = 0.039) or acute limb ischemia (OR = 4.25, P = 0.005). A formal palliative care consult was associated with lower likelihood of
in-hospital death and increased likelihood of discharge to hospice (OR = 0.248, P = 0.0167, OR = 1.283, P < 0.001).There were no statistically significant differences in the code status of
patients who received a palliative care consultation.
In a large academic medical center, palliative medicine consultation was associated
with lower in-hospital mortality among patients with advanced vascular disease and
major limb amputation. These data will hopefully stimulate much needed prospective
research to develop and test tools to identify patients in need and derive evidence
about the impact of palliative care services.