Background <p>Hepatopancreatobiliary (HPB) malignancies are associated with high morbidity and frequent invasive procedures near the end of life. Although palliative care improves quality of life and goal-concordant care, its relationship with procedural burden in HPB cancers at the end of life remains poorly understood. We evaluated associations between inpatient palliative care and end-of-life procedural intensity in HPB malignancies.</p> Methods <p>We conducted a retrospective analysis of adult patients with HPB cancers admitted to a tertiary academic health system within 6 months of death between January 1, 2013, and December 31, 2024. Electronic health records and tumor registry data were analyzed through June 1, 2025. Patients were categorized by inpatient procedures and palliative care consultations. The primary outcome was the relationship between palliative care involvement and inpatient procedural burden. Multivariable logistic regression evaluated associations between palliative care timing and procedural characteristics.</p> Results <p>Among 2,848 patients, 1,373 (48.2%) underwent an inpatient procedure and 1,160 (40.7%) received palliative care consultation. From 2013 to 2024, palliative care utilization more than doubled, while end-of-life procedural rates remained constant. Palliative care involvement prior to any procedure was associated with lower odds of undergoing nonpalliative-intent procedures relative to palliative-intent procedures (odds ratio [OR] 0.71, 95% confidence interval [CI] 0.51–0.98; <i>P</i> = 0.038).</p> Conclusions <p>End-of-life inpatient procedures were common in HPB malignancies and persisted despite increased palliative care utilization. Early palliative care involvement was associated with a greater proportion of palliative-type procedures, suggesting an association between earlier palliative care integration and procedural decision-making that may better align with patient quality of life and end-of-life priorities.</p>