Intraoperative crossover: the well-kept surgical secret to apparent surgical success.
Cardiologists and patients contemplate the risk of proposed operations. Surgeons typically report outcomes on operations performed. Emergency intraoperative crossover from off- to on-pump coronary artery bypass grafting occurs uncommonly but has substantial rates of mortality and morbidity. Much of the reported perioperative benefit of off- compared with on-pump coronary artery bypass grafting is erased if data are presented by intention to treat and not by operation performed. Cardiologists and cardiac surgeons should share the responsibility for advising a patient to consent to a cardiac operation using honestly presented evidence of potential benefits and risks substantiated with information analyzed in patient-centric and not physician-centric ways.
Jones
Robert H
RH
Department of Surgery/Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina 27715, USA. jones060@mc.duke.edu
D013504:Cardiovascular Surgical Procedures / Q000379:methods / Q000706:statistics & numerical data; D001026:Coronary Artery Bypass / Q000379:methods / Q000706:statistics & numerical data*; D047549:Coronary Artery Bypass, Off-Pump / Q000379:methods / Q000706:statistics & numerical data; D006801:Humans; D011183:Postoperative Complications; D010818:Practice Patterns, Physicians'; D014481:United States