Palliative prognostic tools in surgical patients at the end of life: a systematic review

Lee, CW; Wong, AB; Lazarakis, S; Lim, WK; Darvall, J

Author(s): Lee, CW; Wong, AB; Lazarakis, S; Lim, WK; Darvall, J;
Details: Publication Year 2025-06,Volume 134,Issue #6,Page 1648-1660
Journal Title: British Journal of Anaesthesia
Publication Type: Review
Abstract: BACKGROUND: Identifying surgical patients at the end of life (EOL) is the first step in integrating palliative and perioperative practices. Palliative prognostic tools (PPTs) are established frameworks from palliative care that assess patients at risk of early death. We conducted a systematic review investigating PPTs in adult surgical populations, their role in surgical decision-making, and their association with perioperative outcomes. METHODS: A prospectively registered systematic review was performed (PROSPERO registration: CRD42023411303). Ovid MEDLINE, Ovid EMBASE, and Cochrane CENTRAL (Wiley) databases were searched for studies investigating PPTs in surgical patients. The primary outcome was the decision to proceed to surgery; secondary outcomes included mortality, quality of life, palliative care consultation, and EOL documentation completion. Abstract screening, full-text review, and study quality appraisal were performed by two authors independently. Results were synthesised narratively owing to study heterogeneity. RESULTS: Seven studies assessing four different PPTs were included in the review. Studies identified that 12-61% of surgical patients were at the EOL. Patients identified as being at the EOL by a PPT using an illness phase, trajectory approach, or both had an increased in-hospital and 12-month mortality. The impact on decisions to proceed to surgery was uncertain because of conflicting results. Palliative care referral and EOL document completion occurred in <15% of surgical patients at the EOL. No studies described patient-reported outcomes. CONCLUSIONS: Palliative prognostic tools have significant potential for incorporation into preoperative assessment. Future research should focus on preoperative end of life assessments and patient-reported outcomes such as quality of life, decision satisfaction, and disability-free survival.
Publisher: Elsevier
Keywords: Humans; *Palliative Care/methods; Prognosis; *Terminal Care/methods; Quality of Life; *Surgical Procedures, Operative; end of life; palliative care; prognostic tool; serious illness; surgery
Department(s): Palliative Care
Publisher's Version: https://doi.org/10.1016/j.bja.2025.03.008
Terms of Use/Rights Notice: Refer to copyright notice on published article.

Creation Date: 2025-06-02 07:40:43

Last Modified: 2025-06-02 07:41:12