Acute Care/Hospitalization

Many surgeons do not discuss advance directives with their patients before surgery

Surgeons try to do everything to achieve successful outcomes after surgery. Yet, some operations remain high-risk for patient mortality and require life-sustaining care afterwards. Given this thinking, some surgeons may be reticent to discuss advance directives with patients prior to surgery. In fact, a new study finds that such discussions are not routine among surgeons. What's more, some surgeons are not willing to operate on a patient if advance directives will limit postoperative care.

Researchers sent a survey to 2,100 surgeons selected at random. Their subspecialties were vascular surgery, neurosurgery, and cardiothoracic surgery. All were likely to perform high-risk operations on patients with numerous coexisting conditions. The survey asked the surgeons about their beliefs in advance directives, how they communicate with patients about them, and the limitations of life-supporting care. A total of 912 questionnaires were completed.

Nearly all of the surgeons said they discussed with patients the possibility of unanticipated outcomes and need for postoperative life-supporting therapy prior to surgery. However, about half (52 percent) of surgeons discussed advance directives before surgery. In addition, 54 percent admitted that they would not operate on a patient if the advance directives interfered or limited life-supporting therapy. Cardiothoracic surgeons were more likely to decline to operate compared to the other specialists. The researchers suggest that patient preferences be clarified prior to surgery, since advance directives are not specifically designed for high-risk procedures. The study was supported in part by the Agency for Healthcare Research and Quality (HS189960).

See "Use of advance directives for high-risk operations: A national survey of surgeons," by Andrew J. Redmann, B.A., B.S., Karen J. Brasel, M.D., M.P.H., Caleb G. Alexander, M.D., M.S., and Margaret L. Schwarze, M.D., M.P.H., in the March 2012 Annals of Surgery 255(3), pp. 418-423.

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