Table 2. Multivariate Model of Patient Factors Associated With Advance Care Planning Documentation Prior to High-Risk Surgery.
| Characteristic | Unadjusted | Adjusteda | ||
|---|---|---|---|---|
| Odds Ratios (95% CI) | P Value | Odds Ratios (95% CI) | P Value | |
| Age at date of surgery, y | ||||
| 65-74 | 1 [Reference] | NA | 1 [Reference] | NA |
| 75-84 | 1.52 (0.86-2.67) | .15 | 1.55 (0.84-2.84) | .16 |
| ≥85 | 2.01 (1.09-3.70) | .02 | 2.00 (1.03-3.90) | .04 |
| Marital status | ||||
| Married/partnered | 1 [Reference] | NA | 1 [Reference] | NA |
| Singleb | 0.77 (0.46-1.33) | .36 | 0.77 (0.42-1.40) | .40 |
| Other/unknownc | 1.36 (0.69-2.69) | .38 | 1.49 (0.66-3.34) | .34 |
| Office visits in y prior to surgery, No. | ||||
| 0-3 | 1 [Reference] | NA | 1 [Reference] | NA |
| 4-7 | 3.10 (0.86-11.15) | .08 | 3.75 (0.94-15.03) | .06 |
| ≥8 | 12.03 (4.27-33.92) | <.001 | 13.01 (4.07-41.64) | <.001 |
| Race/ethnicity | ||||
| Nonwhite | 1 [Reference] | NA | 1 [Reference] | NA |
| White | 1.75 (0.98-3.00) | .06 | 1.80 (0.97-3.34) | .06 |
| Dementia or mild cognitive impairment diagnosis at time of surgery | ||||
| No | 1 [Reference] | NA | 1 [Reference] | NA |
| Yes | 5.36 (1.53-18.75) | .01 | 6.12 (1.54-24.31) | .01 |
| Serious illness at time of surgeryd | ||||
| No | 1 [Reference] | NA | 1 [Reference] | NA |
| Yes | 1.71 (1.06-2.75) | .03 | 1.64 (0.96-2.80) | .07 |
| Type of surgerye | ||||
| Emergency | 1 [Reference] | NA | 1 [Reference] | NA |
| Elective | 0.6 (0.37-0.97) | .04 | 0.86 (0.50-1.48) | .58 |
Abbreviation: NA, not applicable.
The variables mortality risk, surgery categories, serious illness types, lung dysfunction, neurologic, cardiac, and end-stage renal disease were excluded from multivariate modeling because they were not statistically significant on bivariate analysis.
Single includes single, widowed, divorced, or separated individuals.
Other/unknown indicates that the insurance type was unknown, Medicaid, or MediCal.
Serious illness includes cancer (brain, esophageal, lung, pancreatic, peritoneal, and stomach cancers and secondary malignant neoplasm of respiratory and digestive systems or other specified sites), respiratory disease (lung dysfunction, chronic pulmonary obstructive disease, and cystic fibrosis), cardiac dysfunction (heart failure), and neurologic disorder (amyotrophic lateral sclerosis, dementia, Parkinson disease, and cerebrovascular accident). General palliative care was excluded.
Elective surgery is defined by the presence of a surgery office visit documented in the 6 months prior to the operation; if none was documented within this time frame, the operation was categorized as an emergency.