Elizabeth J Lilley1,2, Sean A Gemunden3, Gentian Kristo4, Navin Changoor1,5, John W Scott1,6, Elizabeth Rickerson7,8, Naomi Shimizu6, Ali Salim1,3,6, Zara Cooper1,3,6. 1. 1 Center for Surgery and Public Health, Brigham and Women's Hospital , Boston, Massachusetts. 2. 2 Department of Surgery, Rutgers-Robert Wood Johnson Medical School , New Brunswick, New Jersey. 3. 3 Surgical ICU Translational Research (STAR) Center , Brigham and Women's Hospital, Boston, Massachusetts. 4. 4 Department of Surgery, Newton-Wellesley Hospital , Newton, Massachusetts. 5. 5 Department of Surgery, Howard University College of Medicine , Washington, DC. 6. 6 Department of Surgery, Harvard Medical School, Brigham and Women's Hospital , Boston, Massachusetts. 7. 7 Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital , Boston, Massachusetts. 8. 8 Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute , Boston, Massachusetts.
Abstract
BACKGROUND: The surprise question is a validated tool for identifying patients with increased risk of death within one year who could, therefore, benefit from palliative care. However, its utility in surgery is unknown. OBJECTIVE: We sought to determine whether the surprise question predicted 12-month mortality in older emergency general surgery patients. DESIGN: This was a prospective cohort study. SETTING/ SUBJECTS: Emergency general surgery attendings and surgical residents in or beyond their third year of training at a single tertiary care academic hospital from January to July 2014. MEASUREMENTS: Surgeons responded to the surprise question within 72 hours of evaluating patients, ≥65 years, hospitalized with an acute surgical condition. Patient data, including demographic and clinical characteristics, were extracted from the medical record. Mortality within 12 months of initial evaluation was determined by using Social Security death data. RESULTS: Ten attending surgeons and 18 surgical residents provided 163 responses to the surprise question for 119 patients: 60% of responses were "No, I would not be surprised" and 40% were "Yes, I would be surprised." A "No" response was associated with increased odds of death within 12 months in binary logistic regression (OR 4.8 [95% CI 2.1-11.1]). CONCLUSIONS: The surprise question is a valuable tool for identifying older patients with higher risk of death, and it may be a useful screening criterion for older emergency general surgery patients who would benefit from palliative care evaluation.
BACKGROUND: The surprise question is a validated tool for identifying patients with increased risk of death within one year who could, therefore, benefit from palliative care. However, its utility in surgery is unknown. OBJECTIVE: We sought to determine whether the surprise question predicted 12-month mortality in older emergency general surgery patients. DESIGN: This was a prospective cohort study. SETTING/ SUBJECTS: Emergency general surgery attendings and surgical residents in or beyond their third year of training at a single tertiary care academic hospital from January to July 2014. MEASUREMENTS: Surgeons responded to the surprise question within 72 hours of evaluating patients, ≥65 years, hospitalized with an acute surgical condition. Patient data, including demographic and clinical characteristics, were extracted from the medical record. Mortality within 12 months of initial evaluation was determined by using Social Security death data. RESULTS: Ten attending surgeons and 18 surgical residents provided 163 responses to the surprise question for 119 patients: 60% of responses were "No, I would not be surprised" and 40% were "Yes, I would be surprised." A "No" response was associated with increased odds of death within 12 months in binary logistic regression (OR 4.8 [95% CI 2.1-11.1]). CONCLUSIONS: The surprise question is a valuable tool for identifying older patients with higher risk of death, and it may be a useful screening criterion for older emergency general surgery patients who would benefit from palliative care evaluation.
Entities:
Keywords:
geriatric surgery; prognostication; surgery
Authors: Judith E Nelson; J Randall Curtis; Colleen Mulkerin; Margaret Campbell; Dana R Lustbader; Anne C Mosenthal; Kathleen Puntillo; Daniel E Ray; Rick Bassett; Renee D Boss; Karen J Brasel; Jennifer A Frontera; Ross M Hays; David E Weissman Journal: Crit Care Med Date: 2013-10 Impact factor: 7.598
Authors: Courtney L Olmsted; Amy M Johnson; Peter Kaboli; Joseph Cullen; Mary S Vaughan-Sarrazin Journal: JAMA Surg Date: 2014-11 Impact factor: 14.766
Authors: Joaquim M Havens; Allan B Peetz; Woo S Do; Zara Cooper; Edward Kelly; Reza Askari; Gally Reznor; Ali Salim Journal: J Trauma Acute Care Surg Date: 2015-02 Impact factor: 3.313
Authors: Alexi A Wright; Nancy L Keating; John Z Ayanian; Elizabeth A Chrischilles; Katherine L Kahn; Christine S Ritchie; Jane C Weeks; Craig C Earle; Mary B Landrum Journal: JAMA Date: 2016-01-19 Impact factor: 56.272
Authors: Mohammed H Al-Temimi; Matthew Griffee; Toby M Enniss; Robert Preston; Daniel Vargo; Sean Overton; Edward Kimball; Richard Barton; Raminder Nirula Journal: J Am Coll Surg Date: 2012-07-11 Impact factor: 6.113
Authors: Elizabeth J Lilley; Kashif T Khan; Fabian M Johnston; Ana Berlin; Angela M Bader; Anne C Mosenthal; Zara Cooper Journal: JAMA Surg Date: 2016-02 Impact factor: 14.766
Authors: Kei Ouchi; Guru Jambaulikar; Naomi R George; Wanlu Xu; Ziad Obermeyer; Emily L Aaronson; Jeremiah D Schuur; Mara A Schonberg; James A Tulsky; Susan D Block Journal: J Palliat Med Date: 2017-08-28 Impact factor: 2.947
Authors: Laura P Gelfman; Harriet Mather; Karen McKendrick; Angela Y Wong; Mathew D Hutchinson; Rachel J Lampert; Hannah I Lipman; Daniel D Matlock; Keith M Swetz; Sean P Pinney; R Sean Morrison; Nathan E Goldstein Journal: J Card Fail Date: 2021-06 Impact factor: 6.592
Authors: Caroline Shulman; Briony F Hudson; Joseph Low; Nigel Hewett; Julian Daley; Peter Kennedy; Sarah Davis; Niamh Brophy; Diana Howard; Bella Vivat; Patrick Stone Journal: Palliat Med Date: 2017-07-03 Impact factor: 4.762