STS 2022 DAY 2 — Today during the session “Lung Transplant: Focus on COVID,” attendees will hear the latest findings on surgical outcomes for patients with COVID-19. Discussion will focus on how COVID positivity affects not only patients but also donors and surgeons, and how factors like cost, quality outcomes ratings, and litigation influence their decisions surrounding palliative care.
John P. Nabagiez, MD, from Albany Medical College in New York, will present results from a survey of cardiothoracic surgeons regarding how they would act, and how they believe their colleagues would act, when faced with making decisions for DNR, DNI, and comfort measures-only (CMO) approaches to care.
The survey was emailed to STS members, requesting demographic information and answers to questions about their views on surgeon-initiated DNR/DNI, family-initiated DNR/DNI, and family-initiated CMO following a significant postoperative complication. Participants also were asked about how quality outcomes reporting, reimbursement/cost measures, and litigation would play a role in their decisions—followed by whether or not they think their colleagues would do the same.
“Cardiothoracic surgeons vary in when they agree with the decision for a patient who suffers a significant complication,” the researchers observed. “There is a disparity in how they believe their colleagues would act in identical scenarios.”
These disparities raise intriguing questions about the culture of cardiothoracic surgery and the factors—including pressure surrounding performance, the social influence of families, and the looming portent of threats to reimbursement and potential lawsuits—that influence surgeons’ tough decisions.
For example, while 72% of respondents said they were certain when a patient should be postoperatively assigned DNR, only 51% said their colleagues would be certain. In the case of DNR requested by the family at any time postoperatively, 75% of respondents reported they would agree, but thought that only 67% of colleagues would. Twenty-six percent of those believed colleagues would agree at a later time after surgery.
As for the factors influencing their decisions, whereas 55% disagreed that quality outcomes reporting would play a role in the timing of when they’d agree to DNR/DNI/CMO, only 31% believed that their colleagues feel the same.
Responses were similarly disparate as to whether reimbursement and cost would play a role—91% denied that finances would influence their decisions, but only 70% thought the same of their colleagues. And when it came to the litigious environment of practice, 64% disagreed that it was a factor, but only 44% were as generous regarding the influence on other surgeons.
Dr. Nabagiez’s presentation is part of “Lung Transplant: Focus on COVID.” The session also highlights historical control propensity scores for extracorporeal membrane oxygenation (ECMO) support in patients with COVID-19, findings that indicate early initiation of veno-venous ECMO improves COVID survival, and an invited talk by Jules Lin, MD, from the University of Michigan Medical Center in Ann Arbor, on the toll COVID takes on surgeons and donors as well as patients. A panel discussion will follow, and attendees can submit their questions during the livestream.
STS 2022 registrants have access to this session and a rich array of other scientific abstracts, compelling lectures, and technology demonstrations—and year-round on-demand access through Annual Meeting Online. Registration is still open at sts.org/annualmeeting.