Patterns of Care in Hospitalized Vascular Surgery Patients at End of Life

IMPORTANCE: There is limited literature reporting circumstances surrounding end-of-life care in vascular surgery patients. OBJECTIVE: To identify factors driving end-of-life decisions in vascular surgery patients. DESIGN, SETTING, AND PARTICIPANTS: In this cohort study, medical records were reviewed for all vascular surgery patients at a tertiary care university hospital who died during their hospitalization from 2005 to 2014. MAIN OUTCOMES AND MEASURES: Patient, family, and hospitalization variables potentially important to influencing end-of-life decisions. RESULTS: Of 111 patients included (67 [60%] male; median age, 75 [range, 24-94] years), 81 (73%) were emergent vs 30 (27%) elective admissions. Only 15 (14%) had an advance directive. Of the 81 (73%) patients placed on comfort care, 31 (38%) had care withheld or withdrawn despite available medical options, 15 (19%) had an advance directive, and 28 (25%) had a palliative care consultation. The median time from palliative care consultation to death was 10 hours (interquartile range, 3.36-66 hours). Comparing the 31 patients placed on comfort care despite available medical options with an admission diagnosis–matched cohort, we found that more than 5 days admitted to the intensive care unit (odds ratio [OR], 4.11; 95% CI, 1.59-10.68; P