The Role of Surgical Care in Pediatric Patients Receiving Palliative Care (GP745)

Abstract

Outcomes 1. Explain the role pediatric surgeons play in the care of children receiving palliative care 2. Express reactions to the data and propose how a new understanding of the incidence of surgical care in pediatric palliative care could change your practice of palliative care Importance The nature of surgical care provided to patients receiving pediatric palliative care (PPC) is not defined, impeding clarification of the role of surgeons in caring for this population and uncovering an opportunity for more informed counseling regarding surgical intervention in palliative care. Objective(s) We sought to characterize the incidence, type, and likely purpose of surgical procedures provided to patients receiving PPC. Method(s) Analyses included children enrolled in a multicenter prospective cohort study of patients receiving PPC. Data were collected between April 2017 and March 2021 and included administrative data regarding all surgical procedures received by the child. Patient demographic characteristics were collected directly from patients’ parents. Procedures were categorized by likely purpose. Descriptive and regression analyses were performed. Results PPC patients (n = 602) averaged 7.1 years of age (SD 6.9). Most were White (72.7%) and non-Hispanic (84.7%) with at least one complex chronic condition (CCC) (99.0%). After initiation of PPC, 61.6% (n = 371) of patients underwent at least one operation (range: 1–71), with a median of 5 (IQR: 2–10). Hardware and catheter placement (38.6%) and biopsy (32.9%) were most common, although patients also underwent resection (9.2%), exploration (5.7%), repair of congenital conditions (cardiac 4.1%, noncardiac 2.4%), and rescue operations (2.4%). The most common operations were feeding tube exchange (6.9%), bone marrow biopsy (3.4%), pyloromyotomy (3.1%), and duodenal resection (2.6%). The odds of surgery did not differ by sex, race, or ethnicity (p > .05), but were associated with increasing age (0.19 more operations per year of age; 95% CI 0.09-0.28; p = .002 and having more CCC (for each additional CCC, the number of operations increased by 1.33; 95% CI 1.02-1.64, p < 0.001). Conclusion(s) Pediatric surgery is a significant component of the care of children receiving palliative care. Impact Given our findings, developing surgeons’ understanding of palliative care and building collaborative relationships between surgical and palliative care teams caring for this shared population is warranted.