Trends in end-of-life care and satisfaction among Veterans undergoing surgery

Abstract: Objective: To examine trends in end-of-life care services and satisfaction among veterans undergoing any inpatient surgery. Background: The Veterans Health Administration has undergone system-wide transformations to improve end-of-life care yet the impacts on end-of-life care services use and family satisfaction are unknown. Methods: We performed a retrospective, cross-sectional analysis of veterans who died within 90 days of undergoing inpatient surgery between January 2010 and December 2019. Using the Veterans Affairs (VA) Bereaved Family Survey (BFS), we calculated the rates of palliative care and hospice use and examined satisfaction with end-of-life care. After risk and reliability adjustment for each VA hospital, we then performed a multivariable linear regression model to identify factors associated with the greatest change. Results: Our cohort consisted of 155,250 patients with a mean age of 73.6 years (SD: 11.6). Over the study period, rates of palliative care consultation and hospice use increased more than two-fold (28.1%-61.1% and 18.9%-46.9%, respectively) while the rate of BFS excellent overall care score increased from 56.1% to 64.7%. There was wide variation between hospitals in the absolute change in rates of palliative care consultation, hospice use, and BFS excellent overall care scores. Rural location and Accreditation Council for Graduate Medical Education accreditation were hospital-level factors associated with the greatest changes. Conclusions: Among veterans undergoing inpatient surgery, improvements in satisfaction with end-of-life care paralleled increases in end-of-life care service use. Future work is needed to identify actionable hospital-level characteristics that may reduce heterogeneity between VA hospitals and facilitate targeted interventions to improve end-of-life care.

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