Patel, RomaTorke, AlexiaNation, BarbCottingham, AnnHur, JenniferGruber, RachelSinha, Shilpee2023-04-112023-04-112021-10-06Patel R, Torke A, Nation B, et al. Crucial Conversations for High-Risk Populations before Surgery: Advance Care Planning in a Preoperative Setting. Palliat Med Rep. 2021;2(1):260-264. Published 2021 Oct 6. doi:10.1089/pmr.2021.0015https://hdl.handle.net/1805/32326Background: High-risk patients undergoing elective surgery are at risk for perioperative complications, including readmissions and death. Advance care planning (ACP) may allow for preparation for such events. Objectives: (1) To assess the completion rate of advance directives (ADs) and their association with one year readmissions and mortality (2) to examine clinical events for decedents. Design: This is an observational cohort study conducted through chart review. Setting/Subjects: Subjects were 400 patients undergoing preoperative evaluation for elective surgery at two hospitals in the United States. Measurements: The prevalence of ADs at the time of surgery and at one year, readmissions, and mortality at one year were determined. Results: Three-hundred ninety patients were included. In total, 102 (26.4%) patients were readmitted, yet did not complete an AD. Seventeen (4.4%) patients filed an AD during follow-up. Nineteen patients died and mortality rate was 4.9%. There was a significant association between completing an AD before death. Of the decedents, seven (37%) underwent resuscitation, but only four had ADs. Conclusions: Many high-risk surgical patients would benefit from ADs before clinical decline. Preoperative clinics present a missed opportunity to ensure ACP occurs before complications arise.en-USAttribution 4.0 InternationalAdvance care planningMortalityPreoperative clinicReadmissionsArticle