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A Surgery Standard Under Fire

A definition of success for doctors, 30 days of survival after an operation, may not serve the interests of older-adult patients.

The New Old Age

By PAULA SPAN

(Martin Leon Barreto)

What she wanted, the patient told the geriatricians evaluating her, was to be able to return to her condominium in Boston. She had long lived there on her own, lifting weights to keep fit and doing her own grocery shopping, until a heart condition worsened and she could barely manage the stairs.

So at 94, she consented to valve replacement surgery at a Boston medical center. “She never wanted to go to a nursing home,” said Dr. Perla Macip, one of the patient’s geriatricians. “That was her worst fear.”

Dr. Macip presented the case on Saturday to a meeting of the American Academy of Hospice and Palliative Medicine. The presentation’s dispiriting title: “The 30-Day Mortality Rule in Surgery: Does This Number Prolong Unnecessary Suffering in Vulnerable Elderly Patients?”

Like Dr. Macip, a growing number of physicians and researchers have grown critical of 30-day mortality as a measure of surgical success. That seemingly innocuous metric, they argue, may actually undermine appropriate care, especially for older adults.

But critics think other quality measures might serve better. Perhaps the benchmark should be 60- or 90-day mortality. Perhaps patients having palliative surgery to relieve symptoms should be tracked separately, because comfort is their goal, not survival.

Maybe quality should include days spent in an I.C.U. or on a ventilator, Dr. Schwarze said.

“Medicine isn’t just about keeping people alive,” she said. “Some of it is about relieving suffering. Some of it is about helping people die.”

A version of this article appears in print on March 3, 2015, on page D1 of the New York edition with the headline: A Surgery Standard Under Fire. Order Reprints| Today’s Paper|Subscribe

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Source: The New York Times (1551 Articles)
Written by Paula Span