Elderly/Long-term Care

One-third of Medicare patients say that the decision about where to undergo surgery was made mainly by their doctor

Numerous government and other organizations wish to disseminate surgeon and hospital volume or mortality data to help patients choose where to have major surgery. The accepted belief is that patients may fare better at hospitals that have been deemed low-mortality or high-volume hospitals. Most Medicare patients participate in the decision of where they should have major elective surgery. Nevertheless, one-third say that the decision was made mainly by their physician, according to a new study supported in part by the Agency for Healthcare Research and Quality (HS13049).

Access to hospital performance data may be very useful for patients who do adopt an active decision-making role. The role of performance data for other patients is less clear, note the researchers. They interviewed 510 randomly selected Medicare patients, who had undergone 1 of 5 elective high-risk operations about 3 years earlier: abdominal aneurysm repair, heart valve replacement surgery, or surgery for bladder, lung, or stomach cancer.

Nearly one-third (31 percent) of patients said their doctor was the main decision maker about where the patient would have surgery; 42 percent said they decided equally; 22 percent said they were the main decisionmaker; and 5 percent said their family helped make the decision for them. These results were similar across patient age, income, and educational attainment. However, men were more likely than women to say the doctor was the main decision maker (34 vs. 24 percent), as were patients in poor to fair health compared with those in good to excellent health (37 vs. 28 percent). The doctor was significantly more likely to be the main decision maker for cardiovascular operations compared with cancer operations (39 vs. 26 percent).

See "Choosing where to have major surgery," by Chad T. Wilson, M.D., Steven Woloshin, M.D., M.S., and Lisa M. Schwartz, M.D., M.S., in the Archives of Surgery 142, pp. 242-246, 2007.

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