Send to

Choose Destination
See comment in PubMed Commons below
Ann Surg. 2014 Mar;259(3):458-63. doi: 10.1097/SLA.0000000000000314.

It's big surgery: preoperative expressions of risk, responsibility, and commitment to treatment after high-risk operations.

Author information

*School of Nursing †Department of Medicine ‡Department of Surgery (Division of Vascular Surgery), and §Department of Medical History and Bioethics, University of Wisconsin, Madison, WI ¶Department of Surgery, Medical College of Wisconsin, Milwaukee, WI ∥Department of Surgery, Division of Trauma, Burns, and Surgical Critical Care, Brigham and Women's Hospital, Boston, MA; and **Department of Surgery and ††Joint Centre for Bioethics, University of Toronto, Toronto, Ontario, Canada.



To identify the processes, surgeons use to establish patient buy-in to postoperative treatments.


Surgeons generally believe they confirm the patient's commitment to an operation and all ensuing postoperative care, before surgery. How surgeons get buy-in and whether patients participate in this agreement is unknown.


We used purposive sampling to identify 3 surgeons from different subspecialties who routinely perform high-risk operations at each of 3 distinct medical centers (Toronto, Ontario; Boston, Massachusetts; Madison, Wisconsin). We recorded preoperative conversations with 3 to 7 patients facing high-risk surgery with each surgeon (n = 48) and used content analysis to analyze each preoperative conversation inductively.


Surgeons conveyed the gravity of high-risk operations to patients by emphasizing the operation is "big surgery" and that a decision to proceed invoked a serious commitment for both the surgeon and the patient. Surgeons were frank about the potential for serious complications and the need for intensive care. They rarely discussed the use of prolonged life-supporting treatment, and patients' questions were primarily confined to logistic or technical concerns. Surgeons regularly proceeded through the conversation in a manner that suggested they believed buy-in was achieved, but this agreement was rarely forged explicitly.


Surgeons who perform high-risk operations communicate the risks of surgery and express their commitment to the patient's survival. However, they rarely discuss prolonged life-supporting treatments explicitly and patients do not discuss their preferences. It is not possible to determine patients' desires for prolonged postoperative life support on the basis of these preoperative conversations alone.

[Indexed for MEDLINE]
Free PMC Article
PubMed Commons home

PubMed Commons

How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for Lippincott Williams & Wilkins Icon for PubMed Central
    Loading ...
    Support Center