Increasing Utilization of Palliative Care is Associated With Reduced Health Care Costs in Operative Trauma: A National Analysis

Abstract

Introduction

Palliative care (PC) has been shown to improve comfort for surgical patients nearing the end of life. Although single-institution studies suggest PC to be a cost-effective strategy, the contemporary national trends in costs and utilization of this modality remain unknown.

Methods

Adult patients (≥18 years) who did not survive following hospitalization for surgical management of traumatic injury were tabulated in the 2016 to 2020 Nationwide Readmissions Database. Patients were stratified by receipt of PC. Entropy balancing on key covariates was used to ensure an equivalent comparison of groups. A multivariable linear regression model was constructed to assess the association between PC and hospitalization costs per day across quintiles of injury severity.

Results

Of an estimated 56 431 patients who did not survive hospitalization for traumatic injury, 43.7% received PC. Compared to others, those receiving PC were older (77 [64-87] vs 73 years [55-85], P < 0.001), insured by Medicare (65.3 vs 58.6%, P < 0.001), and had a higher Elixhauser Comorbidity Index (4 [3-6] vs 4 [2-6], P < 0.001). Following multivariable adjustment and entropy balancing, PC was associated with a decrement in daily costs (β, $1,300, 95% confidence interval −1500 to −1,000, P < 0.001). Such difference was greatest among those in the highest quintile of injury severity.

Conclusion

We demonstrate a potential cost benefit to the utilization of PC for trauma patients nearing end of life. In the context of known benefits of PC to quality of life for acutely ill patients, our findings highlight the economic feasibility of integrating PC into trauma services.