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Factors Associated With Provision of Nonbeneficial Surgery: A National Survey of Surgeons. | LitMetric

AI Article Synopsis

  • The study aimed to understand how various systems factors influence surgeons' decisions to offer surgical interventions to older adults facing serious, life-limiting conditions.
  • A national survey was sent to 5200 surgeons, revealing that 40% were willing to perform surgery on an elderly patient with severe health issues, while 60% preferred comfort care; the availability of an operating room and family requests significantly affected decisions.
  • The findings suggest that external factors, such as family dynamics and hospital resources, play a critical role in the tendency to perform surgeries that may not benefit the patient, indicating a need for better decision-making processes in serious illness care.

Article Abstract

Objective: We tested the association of systems factors with the surgeon's likelihood of offering surgical intervention for older adults with life-limiting acute surgical conditions.

Background: Use of surgical treatments in the last year of life is frequent. Improved risk prediction and clinician communication are solutions proposed to improve serious illness care, yet systems factors may also drive receipt of nonbeneficial treatment.

Methods: We mailed a national survey to 5200 surgeons randomly selected from the American College of Surgeons database comprised of a clinical vignette describing a seriously ill older adult with an acute surgical condition, which utilized a 2×2 factorial design to assess patient and systems factors on receipt of surgical treatment to surgeons.

Results: Two thousand one hundred sixty-one surgeons responded for a weighted response rate of 53%. For an 87-year-old patient with fulminant colitis and advanced dementia or stage IV lung cancer, 40% of surgeons were inclined to offer an operation to remove the patient's colon while 60% were inclined to offer comfort-focused care only. Surgeons were more likely to offer surgery when an operating room was readily available (odds ratio: 4.05, P <0.001) and the family requests "do everything" (odds ratio: 2.18, P <0.001).

Conclusions: Factors outside the surgeon's control contribute to nonbeneficial surgery, consistent with our model of clinical momentum. Further characterization of the systems in which these decisions occur might expose novel strategies to improve serious illness care for older patients and their families.

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9905263PMC
http://dx.doi.org/10.1097/SLA.0000000000005765DOI Listing

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