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Research Letter
December 5, 2018

Advance Care Planning in Older Adults With Multiple Chronic Conditions Undergoing High-Risk Surgery

Author Affiliations
  • 1Division of Geriatrics, Department of Medicine, University of California, San Francisco
  • 2Division of Hospital Medicine, Department of Medicine, Veterans Affairs Medical Center, San Francisco, California
  • 3Palo Alto Medical Foundation Research Institute, Palo Alto, California
  • 4School of Medicine, University of California–San Diego, La Jolla
  • 5Division of Geriatrics, Veterans Affairs Heath Care System, San Francisco, California
  • 6Innovation and Implementation Center for Aging and Palliative Care, Division of Geriatrics, Department of Medicine, University of California, San Francisco
JAMA Surg. Published online December 5, 2018. doi:10.1001/jamasurg.2018.4647

More than 4 million high-risk operations (those that are associated with ≥1% in-hospital mortality) are performed annually in the United States in patients 65 years or older.1 While operative risk has declined over time, many older adults, especially those with multiple chronic conditions, remain at high risk for postoperative morbidity (including loss of independence and/or functional decline) and mortality.2,3 Therefore, the American College of Surgeons and American Geriatric Society jointly recommend patients engage in advance care planning (ACP), which includes documenting a patient’s personal goals and values, treatment preferences, and surrogate decision maker.4 In this study, we determined the prevalence and patient characteristics associated with ACP documentation among elderly adults at any time prior to high-risk surgery.

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