Redesigning Surgical Decision Making for High-Risk Patients

Shared decision making in surgical care requires a culture shift. For patients at high risk for adverse events after surgery, or in cases with an equivocal risk-benefit balance, evidence-based decision making may require input from a multidisciplinary group of experts. An 80-year-old nursing home resident has a colon mass and has been scheduled for a colectomy. Has he been told that 30% of elderly nursing home patients who undergo colectomy die within 3 months after the surgery and that 40% of the survivors have a significant decline in functional status, or that 12 months after surgery, half the patients have died and half the survivors have a sustained functional decline?(1) One third of elderly Americans undergo surgery during the last 12 months of their lives, most of them within the last month.(2) Yet three quarters of seriously ill patients say ...