"Kwok and colleagues’ study shows that the provision of appropriate, preference-guided treatment for patients with serious illness is the shared responsibility of all clinicians," Dr. Kelley commented. "Surgeons, like general practitioners, are obliged to work with patients and their families to identify appropriate goals of care and recommend treatment plans that help achieve those goals."
The study did not include the approximately 44% of surgical procedures performed in outpatient settings, a potential limitation. Also, although they adjusted for risk factors for death, Dr. Kwok and his colleagues acknowledged that some comorbidities could have been caused by the surgical intervention itself.
Dr. Kelley addressed another potential limitation: "Certainly, studies relying solely on administrative and census data cannot sufficiently adjust for patients’ risk factors (i.e., health, function, and socioeconomic status), or for patients’ or families’ preferences; and studies of decedents cannot fully account for those who survived despite a high risk of mortality. Nevertheless, the consistent reproducible pattern of findings across many studies cannot be ignored. Treatments are heavily influenced by external factors (i.e., number of hospital beds per head, local practice patterns, physician supply), rather than purely what is medically appropriate for and preferred by patients. Although some might continue to critique such study methods, including those used by Kwok and colleagues, the weight of evidence supports the need for action on many levels."
There was no sponsor for this study. Dr. Kwok and his study coauthors, as well as Dr. Kelley, had no relevant financial disclosures.