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Beyond 30-Day Mortality Aligning Surgical Quality With Outcomes That Patients Value

Margaret L. Schwarze, MD, MPP1,2; Karen J. Brasel, MD, MPH3; Anne C. Mosenthal, MD4
[+] Author Affiliations
1Division of Vascular Surgery, Department of Surgery, University of Wisconsin–Madison
2Department of Medical History and Bioethics, University of Wisconsin–Madison
3Department of Surgery, Medical College of Wisconsin, Milwaukee
4Department of Surgery, New Jersey Medical School, Rutgers University, Newark
JAMA Surg. 2014;149(7):631-632. doi:10.1001/jamasurg.2013.5143.
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Because of their strong sense of responsibility for the lives of patients, surgeons frequently struggle to withdraw postoperative life-supporting treatments when patients or their families request it.1 Although surgeons experience this as therapeutic optimism or the emotional pull of error and responsibility, these forces are accentuated by the increasing emphasis on 30-day mortality reporting. The recent expansion of outcomes profiling imposes an unconscious bias in these critical decisions: surgeons who report concern about physician profiling are more likely to decline to operate on a patient who prefers to limit life support, or are more likely to refuse to withdraw life support postoperatively, than surgeons who perceive less pressure from outcomes reporting.2,3

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