Most surgeons expect patients to buy-in to postoperative life support prior to high-risk surgery
How likely is it that the surgeon will follow through with a patient’s wishes on postoperative life support? According to a new national survey, a majority of surgeons expect patient buy-in to postoperative life support during pre-operative consultations about high-risk surgery.
Of the surgeons who responded to the survey, 62 percent reported that they would seek an informal preoperative agreement with the patient about limits to aggressive therapy, including life support. Very few surgeons (6 percent) said they would sometimes or always withdraw life support at postoperative day 1 of a high-risk operation at the request of the patient or their surrogate. However, by postoperative day 14, 85 percent would consider doing so. If a patient was at moderate risk of needing long-term ventilator support or dialysis, but had a specific request to limit specific life support treatments following surgery, 60 percent of the surgeons would not agree to perform the operation.
Those most likely to create an informal contract on postoperative life support with a patient were 2.1 times more likely to believe it was acceptable to withdraw life support on the 14th day after surgery; 30 percent more likely to be vascular rather than cardiothoracic surgeons; and 2.8 times more likely to do 11 or more high-risk operations per month than none per month.
Among the surgeons who would decline to operate on a patient who wanted to limit postoperative life support, the significant factors were being a cardiothoracic rather than a vascular surgeon (40 percent more likely), being in private practice without an academic affiliation (20 percent more likely than a surgeon in an academic practice), and being somewhat or very concerned about outcomes profiling of physicians (40 percent more likely).
The researchers sent surveys to 2,100 cardiothoracic, vascular, and neurosurgeons and received 912 completed questionnaires. The study was funded in part by AHRQ (HS15699 and HS18996).
More details are in "Surgeons expect patients to buy-in to postoperative life support preoperatively: Results of a national survey," by Margaret L. Schwarze, M.D., M.P.P., Andrew J. Redmann, B.S., G. Caleb Alexander, M.D., M.S., and others, in the January 2013 Critical Care Medicine 41(1), pp. 1-8.