Post-Op Life Support

Limiting life support after surgery can make some surgeons reluctant to proceed

(RxWiki News) It’s important for patients to fully understand the possibilities of post-operative complications. But restricting life support can make some surgeons run for the hills.

A recent study surveyed surgeons about how they would handle patients who opted for limited life support after high-risk surgeries. Surgical outcomes are publicly reported and can affect a surgeon’s career.

Many surgeons said they would refuse to perform surgery on patients unless they opted for lengthier life support options.

"Talk to your surgeon about surgery risks."

Margaret “Gretchen” Schwarze, MD, MPP, assistant professor of surgery at the University of Wisconsin School of Medicine and Public Health, was the lead author of this study. For the study, 2,100 cardiothoracic, vascular and neurological surgeons were surveyed about how they approached postoperative life support decisions with patients before surgeries.

The survey offered a preoperative surgical scenario where the patient requested limited life support after a high-risk, but non-emergency surgery with a moderate risk for complications. Only 924 surgeons or 56 percent completed the survey. A total of 62 percent said they informally spoke with patients before surgery to describe limitations of aggressive therapies such a breathing machines and dialysis.

During these talks, they said they made informal contracts with patients for postoperative plans of action concerning aggressive therapies.

Another 60 percent said they sometimes or always refused to operate if a patient preferred to limit life support after surgery.

Surgeons who felt it was acceptable to remove life support on day 14 after surgery were about twice as likely to talk to patients about life support beforehand as surgeons who did not feel it was acceptable.

Overall, 72 percent reported being willing to negotiate the time period for life support to continue or end after surgery.

Only 27 percent reported they would communicate to a patient that they would not be willing to honor the patients’ desire to keep life support limited.

Surgical outcomes and postoperative complications are put on a publicly accessible record and can reflect upon the surgeon and contribute to his or her reputation.

Dr. Schwarze said, “We knew that surgeons generally believe that their patients ‘buy in’ to the use of life-supporting treatments after surgery, but we were surprised that many surgeons simply refuse to do an operation without the patient’s commitment to postoperative treatment.”

“Surgeons obviously have a strong aversion to being ‘agents of death,’ and they struggle with issues that link their performance to patient outcomes, particularly when their hands are tied by postoperative restrictions.”

This study was published in December in Critical Care Medicine. Funding was supported by the Society of Critical Care Medicine and Lippincott Williams & Wilkins. No conflicts of interest were reported.

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Review Date: 
December 21, 2012