Research Activities February 2013, No. 390
Surgeons are more reluctant to withdraw postoperative life support for patients with complications from surgeon error
Patient Safety and Quality
Surgeons embrace the notion of personal responsibility for the surgical patient. This tradition has contributed to success in prolonging and improving patients' quality and length of life through surgical interventions. In some settings however, the surgeon's personal responsibility may conflict with patient autonomy when the surgeon is reluctant to withdraw life support after a poor outcome, despite a preference expressed by the patient for withdrawal of aggressive care. In fact, a new study reveals that surgeons are more reluctant to withdraw postoperative life-supporting therapy for patients with complications from surgeon error in elective rather than emergency surgeries.
The researchers surveyed 912 surgeons to find their reactions to a hypothetical vignette of a specialty-specific operation complicated by a hemiplegic stroke and respiratory failure. A premise of the vignette was that on postoperative day 7, the patient and family requested withdrawal of life-supporting therapy. In response, 63 percent of the surgeons reported that they would not honor the request for withdrawal of life-supporting treatment. Surgeons who were told that the patient's complication was the result of surgeon error were significantly less likely to withdraw support than their colleagues who encountered a complication based on other factors (33 percent vs. 41 percent). Similarly, surgeons queried about an elective operation were less likely to withdraw life-supporting therapy than those queries about surgery in an emergency setting (33 percent vs. 41 percent). Differences by specialty emerged, with cardiothoracic and neurosurgeons being less likely to withdraw life-support than vascular surgeons (30 and 37 vs. 45 percent).
The data suggest that commission of an error in surgical technique and prognostic optimism may present a challenge to patient autonomy. Particularly in settings in which there is a disagreement between patients and their families and the treating physician, the findings highlight the importance of frank discourse and, when needed, consultation with other disinterested parties in order to navigate what may be difficult postoperative decisionmaking.
The findings were based on a survey of members of regional vascular surgery societies, the Society of Thoracic Surgeons, and the Cerebrovascular Section of the American Association of Neurological Surgeons. The study was supported in part by the Agency for Healthcare Research and Quality (HS18960).
See "The role of surgeon error in withdrawal of postoperative life support," by Margaret L. Schwarze, M.D., Andrew J. Redmann, B.A., Karen J. Brasel, M.D., and G. Caleb Alexander, M.D., in the Annals of Surgery 256, pp. 10-15, 2012.