Patient-Centered Outcomes and Preoperative Discussions

Abstract

Surgeons and patients can have differing opinions about whether a procedure will improve patients' health or quality of life. 1 Not infrequently, patients or families advocate for an intervention even when surgeons recommend otherwise. The Joint Commission defines informed consent as follows: "A patient must be apprised of the nature, risks, and alternatives," a definition that excludes any obligation to discuss functional outcomes. 2 The nextlevel metric, patient-centered outcomes (PCO), such as days spent at home, shifts the focus to a patient's quality of life and ability to return to their preoperative functional status. 3,4 Jacobs and colleagues 5 described a novel PCO-patient trajectories after surgery measured by "days elsewhere from home." Notably, in Jacobs and colleagues' analysis, trajectories start 275 days before a procedure and end 365 days after, highlighting the impact of surgery beyond the traditional 30-day end point. They identified 5 trajectories in a population of patients receiving care at Veterans Affairs hospitals undergoing both elective and nonelective surgery. Three of these trajectories (T1, T2, and T3) reflected varying speeds of recovery and return to baseline, and another (T5) reflected patients who were chronically dependent preoperatively and, unsurprisingly, remained so postoperatively. The final trajectory (T4) represented the 1.3% to 5.2% of patients who were independent preoperatively and bec ame dependent in the yearlong postoperative period. Significantly, irrespective of age, available preoperative variables, such as health factors, frailty, and