Surgeon-reported conflict with intensivists about postoperative goals of care

Abstract

Objective: To examine surgeons' experiences of conflict with intensivists and nurses about goals of care for their postoperative patients.

Design: Cross-sectional incentivized US mail-based survey.

Setting: Private and academic surgical practices.

Participants: A total of 2100 vascular, neurologic, and cardiothoracic surgeons.

Main outcome measures: Surgeon-reported rates of conflict with intensivists and nurses about goals of care for patients with poor postsurgical outcomes.

Results: The adjusted response rate was 55.6%. Forty-three percent of surgeons reported sometimes or always experiencing conflict about postoperative goals of care with intensivists, and 43% reported conflict with nurses. Younger surgeons reported higher rates of conflict than older surgeons with both intensivists (57% vs 32%; P = .001) and nurses (48% vs 33%; P = .001). Surgeons practicing in closed intensive care units reported more frequent conflict than those practicing in open intensive care units (60% vs 41%; P = .005). On multivariate analysis, the odds of reporting conflict with intensivists were 2.5 times higher for surgeons with fewer years of experience compared with their older colleagues (odds ratio, 2.5; 95% CI, 1.6-3.8) and 70% higher for reporting conflict with nurses (odds ratio, 1.7; 95% CI, 1.1-2.6). The odds of reporting conflict with intensivists about goals of postoperative care were 40% lower for surgeons who primarily managed their intensive care unit patients than for those who worked in a closed unit (odds ratio, 0.60; 95% CI, 0.40-0.96).

Conclusions: Surgeons regularly experience conflict with critical care clinicians about goals of care for patients with poor postoperative outcomes. Higher rates of conflict are associated with less experience and working in a closed intensive care unit.