Become a member and receive career-enhancing benefits
Our top priority is providing value to members. Your Member Services team is here to ensure you maximize your ACS member benefits, participate in College activities, and engage with your ACS colleagues. It's all here.
Become a member and receive career-enhancing benefits
Our top priority is providing value to members. Your Member Services team is here to ensure you maximize your ACS member benefits, participate in College activities, and engage with your ACS colleagues. It's all here.
Providing accurate information based on a complete understanding of the preferences and beliefs of the patient, their family members, and surrogate caregivers is a critical component of “shared decision-making” and the informed consent process. When a proposed surgical procedure is high risk, discussions of potential futility of care, risk of mortality, and appropriate use of nonoperative care are necessary. In this study, Matthew Dellen and coauthors attempted to improve the value of the information provided during these exchanges by assessing the factors deemed most important by patients. They used a survey instrument and presented emergency surgery scenarios to layperson participants (N=236). Responses were rated on a four-point scale.
The data showed that chance of survival was the most important factor for 69.3% of respondents; other important factors were estimated life span without surgery, postoperative function and pain status, and surgery cost. Surgery was the treatment option chosen most often when the chance of postoperative functional independence was high. The authors concluded that improved surgeon understanding of the factors patients and families feel are important when making treatment choices would increase the effectiveness of preoperative shared decision-making discussions.
Carotid Endarterectomy, Stenting, or Best Medical Treatment for Moderate-to-Severe Asymptomatic Carotid Artery Stenosis
This article reports outcomes of a randomized prospective trial that compared carotid endarterectomy (CEA) plus best medical therapy (BMT) to BMT alone in one group and carotid stenting (CAS) plus BMT with BMT alone in a second group of asymptomatic patients with distal carotid artery and/or internal carotid artery stenosis of 70% or greater. The study cohort consisted of 513 patients from 36 European centers. The outcomes of interest were rates of stroke and death over a 5-year follow-up interval.
Five strokes occurred in the entire cohort during the first 30 days after treatment began. The analysis showed that the primary outcomes were observed in similar proportions of all treatment groups. During the 5-year follow-up interval, no ipsilateral strokes were observed in the CEA plus BMT group, but three strokes occurred in the CAS plus BMT and BMT alone groups. The authors concluded that CEA or CAS plus BMT did not meet criteria for superiority compared with BMT alone for prevention of ipsilateral stroke in asymptomatic patients with carotid stenosis. They urged readers to interpret the findings with caution because of the small sample size.
Examining Adherence to TQIP Palliative Care Guidelines
Available clinical practice guidelines recommend that surgeons caring for seriously injured patients deliver palliative care—defined as care designed to provide maximum patient quality of life and comfort delivered along with discussions of goals of care (GOC) delivered with 72 hours of admission—in parallel with life-sustaining care. The aim of this study was to determine adherence rates for the palliative care guidelines published in the ACS Trauma Quality Improvement Program (TQIP).
Retrospective data on 486 patients from a single center were included; guideline adherence was confirmed in only 18.9% of the study group. Confirmed guideline adherence was associated with a requirement for mechanical ventilation and/or presence of multiple serious illness criteria. The authors provided data confirming that their findings were like previously published studies. They concluded that adherence to guidelines was not improving and that system-level interventions to remedy this situation were indicated.
In the editorial that accompanied the article, Mark R. Katlic, MD, FACS, provided a useful GOC documentation form that can be used to provide evidence in the patient record that the GOC discussion occurred; this information would provide useful data for quality improvement initiatives.
