Abstract：
BACKGROUND:Surgical patients increasingly have more comorbidities and are of an older age, complicating surgical decision-making in emergent situations. Little is known about surgeons' perceptions of shared decision-making in these settings. STUDY DESIGN:Twenty semi-structured interviews were conducted with practicing surgeons at 2 large academic medical centers. Thirteen questions and 2 case vignettes were used to assess perceptions of decision-making, considerations when deciding whether to offer to operate, and communication patterns with patients and families. RESULTS:Thematic analysis revealed 6 major themes: responsibility for the decision to operate, perceived futility, surgeon judgment, surgeon introspection, pressure to operate, and costs of the operation. Perceived futility was universally considered a contraindication to surgical intervention. However, the challenge of defining futility led participants to emphasize the importance of patients' self-determined risk-to-benefit analysis when considering surgical intervention. More experienced surgeons reported greater comfort with communicating to patients that a condition was not amenable to an operation and reserved the right to refuse to operate. CONCLUSIONS:Due to external pressures and uncertainty, some providers err on the side of operative intervention, despite suspected futility. Greater experience allows surgeons to withstand external pressures, be confident in their assessments of perceived futility, and guide patients and their families away from additional interventions.
journal_name
J Am Coll Surgjournal_title
Journal of the American College of Surgeonsauthors
Morris RS,Ruck JM,Conca-Cheng AM,Smith TJ,Carver TW,Johnston FMdoi
10.1016/j.jamcollsurg.2018.01.008subject
Has Abstractpub_date
2018-05-01 00:00:00pages
784-795issue
5eissn
1072-7515issn
1879-1190pii
S1072-7515(18)30061-9journal_volume
226pub_type
杂志文章,多中心研究abstract：BACKGROUND:Although RBC transfusions can be lifesaving, recent evidence suggests that their use is associated with added morbidity and mortality and that a lower transfusion threshold is safe. It is unclear if this new evidence has translated into decreased RBC use among surgical patients. The purpose of this study is ...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
doi：10.1016/j.jamcollsurg.2008.04.002
更新日期：2008-09-01 00:00:00
abstract：BACKGROUND:Performance measurement has become central to surgical practice. We systematically reviewed all endorsed performance measures from the National Quality Forum, the national clearing house for performance measures in health care, to identify measures relevant to surgical practice and describe measure stewardsh...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
doi：10.1016/j.jamcollsurg.2014.06.018
更新日期：2014-11-01 00:00:00
abstract：BACKGROUND:Injured patients cared for in trauma centers have a lower risk of death than those cared for in nontrauma centers. However, many patients are transported to a non-trauma center after injury (undertriaged) and require transfer to trauma center care. Previous analyses of undertriage focused only on survivors t...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
doi：10.1016/j.jamcollsurg.2010.08.014
更新日期：2010-12-01 00:00:00
abstract：BACKGROUND:A minority of liver transplantation (LT) candidates pursue listing at multiple centers to achieve transplantation. The purpose of this study was to assess the characteristics and outcomes of the migrated LT candidates, that is, those who travel to secondary centers seeking LT. STUDY DESIGN:Single-center ret...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
doi：10.1016/j.jamcollsurg.2013.12.056
更新日期：2014-06-01 00:00:00
abstract：BACKGROUND:Theoretical advantages of random-intercept multilevel (ML) logistic regression (LR) modeling over standard LR include separating variability due to patient-level and hospital-level predictors, shrinkage of estimates for lower-volume hospitals toward the overall mean, and fewer hospitals falsely identified as...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章,多中心研究
doi：10.1016/j.jamcollsurg.2010.03.033
更新日期：2010-08-01 00:00:00
abstract：BACKGROUND:Hemorrhage can modify the leukocyte-endothelial cell response leading to tissue injury. The selectin family of adhesion molecules and chemokines mediate the leukocyte-endothelial cell interaction, resulting in neutrophil sequestration and activation. This work studies whether a small molecule inhibitor of se...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
doi：10.1016/s1072-7515(99)00213-6
更新日期：1999-12-01 00:00:00
abstract：BACKGROUND:Expression of estrogen receptor-alpha (ERalpha) as determined by immunohistochemistry of tumor tissue is currently the most clinically useful test to predict hormone responsiveness of breast cancer. Thirty percent of ERalpha-positive breast cancers do not respond to hormonal therapy. GATA-3 is a transcriptio...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
doi：10.1016/j.jamcollsurg.2004.12.025
更新日期：2005-05-01 00:00:00
abstract：BACKGROUND:Type or lack of insurance may affect access to care, treatment, and outcomes. We evaluated trends for surgical management of all peripheral arterial disease (PAD) in-hospital admissions by insurer status in New York State. STUDY DESIGN:Statewide Planning and Research Cooperative System (SPARCS) data were ob...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
doi：10.1016/j.jamcollsurg.2012.05.033
更新日期：2012-09-01 00:00:00
abstract：BACKGROUND:We sought to identify variables associated with American Board of Medical Specialties (ABMS)-member board certification and lack thereof among US medical graduates who planned at medical school graduation to become certified in surgery and entered graduate medical education in general surgery. STUDY DESIGN:...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
doi：10.1016/j.jamcollsurg.2012.01.049
更新日期：2012-05-01 00:00:00
abstract：BACKGROUND:There is great interest in efficiently evaluating health care quality, but there is controversy over the use of administrative versus clinical data methods. We sought to compare actual mortality with risk-adjusted expected mortality in a sample population calculated by two different methods; one based on pre...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
doi：10.1016/j.jamcollsurg.2007.08.013
更新日期：2007-12-01 00:00:00
abstract：BACKGROUND:There is increasing interest in surgical outcomes. The Patient Safety in Surgery (PSS) Study database was examined about thyroid and parathyroid procedures to determine risk factors for adverse outcomes and outcomes rates. Relative outcomes performance for the Veterans Affairs (VA) and private-sector populat...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
doi：10.1016/j.jamcollsurg.2007.02.073
更新日期：2007-06-01 00:00:00
abstract：BACKGROUND:It has been suggested that laparoscopic antireflux surgery has been associated with an increased incidence of postoperative paraesophageal hiatus herniation, and that this comes (at least in part) from not performing an esophageal lengthening procedure in patients with preoperative esophageal shortening. Thi...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
doi：10.1016/s1072-7515(00)00363-x
更新日期：2000-10-01 00:00:00
abstract：INTRODUCTION:An effective strategy to manage acute pain while minimizing opioid exposure is needed for injured patients. In this trial, we aimed to compare two multimodal pain regimens (MMPR) in minimizing opioid exposure and relieving acute pain in a busy, urban trauma center. METHODS:This was an unblinded, pragmatic...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
doi：10.1016/j.jamcollsurg.2020.12.014
更新日期：2020-12-29 00:00:00
abstract：BACKGROUND:Poor access to adequate health care coverage is associated with poor outcomes for many chronic medical conditions. We hypothesized that insurance coverage is also associated with mortality after gunshot trauma. STUDY DESIGN:The trauma records for gunshot victims and their insurance status were reviewed at o...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
doi：10.1016/j.jamcollsurg.2009.12.002
更新日期：2010-03-01 00:00:00
abstract：BACKGROUND:Patient comprehension during surgical informed consent remains problematic. Using data from our randomized trial of methods to improve informed consent comprehension, we performed an additional analysis to define independent factors associated with improved patient understanding. STUDY DESIGN:Patients sched...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章,多中心研究,随机对照试验
doi：10.1016/j.jamcollsurg.2010.02.049
更新日期：2010-06-01 00:00:00
abstract：BACKGROUND:Pancreas transplants are still associated with the highest surgical complication rate of all routinely performed solid organ transplants. To date, the impact of serious surgical complications in the cyclosporine era on perioperative patient morbidity, graft and patient survival, and hospital costs has not be...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
doi：10.1016/s1072-7515(01)00895-x
更新日期：1997-08-01 00:00:00
abstract：BACKGROUND:Metabolic syndrome (MetS) increases cardiovascular risk and is associated with poor patient outcomes. We hypothesized that MetS confers an increased risk of morbidity and mortality in severely injured trauma patients. STUDY DESIGN:We performed a retrospective review of trauma patients from 2014 through 2018...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
doi：10.1016/j.jamcollsurg.2019.09.009
更新日期：2020-01-01 00:00:00
abstract：:The clinical outcome of 453 patients with histologically confirmed adenocarcinoma surveyed from 1980 to 1992 was evaluated. Special consideration was given to the prognostic significance of local recurrence and distant metastases as the significant contributors to postoperative morbidity and mortality. Of 453 patients...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
doi：
更新日期：1994-03-01 00:00:00
abstract：BACKGROUND:Transfusion practice among surgeons varies despite several trials supporting the restrictive use of blood products. We sought to define the variation in surgeon transfusion hemoglobin (Hb) triggers and targets among patients undergoing hepatopancreaticobiliary (HPB) procedures, as well as assess perioperativ...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
doi：10.1016/j.jamcollsurg.2014.02.033
更新日期：2014-08-01 00:00:00
abstract：BACKGROUND:In the past, type 2 (C-peptide positive) diabetes mellitus (DM) was a contraindication for simultaneous pancreas-kidney transplantation (SPKT). STUDY DESIGN:We retrospectively analyzed outcomes in SPKT recipients according to pretransplantation C-peptide levels ≥ 2.0 ng/mL or < 2.0 ng/mL. RESULTS:From Nove...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
doi：10.1016/j.jamcollsurg.2014.12.020
更新日期：2015-04-01 00:00:00
abstract：BACKGROUND:Although c-myc expression in carcinoma of the stomach has been reported to be involved in progression of the disease, little is known about the mechanism or significance of its expression. STUDY DESIGN:We measured c-myc messenger RNA (mRNA) levels by Northern blot hybridization in 51 primary gastric carcino...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
doi：
更新日期：1996-01-01 00:00:00
abstract：BACKGROUND:Voluntary resident attrition remains problematic despite recent changes in postgraduate general surgery training, including reduction of work hours. STUDY DESIGN:We conducted a prospective study of all postgraduate year (PGY)-1 and -2 trainees on the 2008 American Board of Surgery resident roster (ABS-RR) w...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
doi：10.1016/j.jamcollsurg.2012.11.005
更新日期：2013-03-01 00:00:00
abstract：BACKGROUND:Recent changes in the educational environment and in the content of specialty surgical education have highlighted limitations, both educational and logistic, of the current system of graduate surgical education. To address these issues, the Graduate Medical Education Committee of the American College of Surg...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
doi：10.1016/s1072-7515(97)00130-0
更新日期：1998-01-01 00:00:00
abstract：BACKGROUND:The majority of newly diagnosed breast cancers in the US are in women aged older than 65 years who can have additional comorbidities. Balancing the risks and benefits of treatment should take into account these competing risks of death. STUDY DESIGN:The Surveillance, Epidemiology, and End Results Program-Me...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章,多中心研究
doi：10.1016/j.jamcollsurg.2019.03.013
更新日期：2019-07-01 00:00:00
abstract：BACKGROUND:The management of dysplasia arising in Barrett's esophagus is controversial. STUDY DESIGN:Twenty patients (group 1, prompt attitude) underwent operation as soon as high-grade dysplasia (HGD) was discovered (n = 8) or just after either the presence of HGD was confirmed (n = 9) or invasive carcinoma (IC) was ...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
doi：10.1016/S1072-7515(03)00417-4
更新日期：2003-09-01 00:00:00
abstract：BACKGROUND:Patients with necrotizing pancreatitis (NP) have the highest rate of venous thromboembolism (VTE) of any hospitalized patient (57%). We hypothesized that VTE prophylaxis might be inadequate in the setting of this profound inflammatory disease and that early detection of deep vein thrombosis would limit pulmo...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
doi：10.1016/j.jamcollsurg.2020.08.774
更新日期：2021-01-01 00:00:00
abstract：BACKGROUND:Daily spontaneous-breathing trials (SBTs) are promulgated as the best method for assessing readiness for discontinuation of mechanical ventilation. SBT protocols have also been shown to improve outcomes as opposed to wild-type implementation of daily SBT recommendations. Here we determine whether implementat...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
doi：10.1016/j.jamcollsurg.2007.08.022
更新日期：2008-03-01 00:00:00
abstract：BACKGROUND:As the use of Papanicolaou cytologic screening became widespread in the United States of America, there was a shift toward diagnosis of earlier clinical stages in patients with carcinoma of the cervix. This increase in early stage disease has also resulted in increased use of surgery as the primary treatment...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
doi：
更新日期：1996-10-01 00:00:00
abstract：BACKGROUND:Trauma is the leading cause of death and disability for individuals under age 55. Many severely injured trauma patients experience complicated clinical courses despite appropriate initial therapy. We sought to identify novel circulating metabolomic signatures associated with clinical outcomes following traum...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
doi：10.1016/j.jamcollsurg.2020.12.022
更新日期：2021-01-14 00:00:00
abstract：BACKGROUND:Stakeholders derive many benefits from cancer clinical trials, including guidance for future oncologic treatment decisions. However, whether enrollment in cancer trials also improves patient survival independently of trial outcomes remains underinvestigated. We hypothesized that cancer trial enrollment is no...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
doi：10.1016/j.jamcollsurg.2012.12.036
更新日期：2013-04-01 00:00:00
