title: Potential Conflicting Interests for Surgeons in End-of-Life Care.
abstract: Thirty-day mortality represents a variable that is commonly used to measure the quality of surgical care. The definition of 30-day mortality and the application of a risk adjustment to its measurement may vary among different organizations comparing physician quality. In the midst of this confusion, conflicting interests arise for surgeons who must weigh the potential benefit of surgical interventions to individual patients versus the potential loss of access by future patients should 30-day mortality ratings be adversely affected. Similarly, surgeons may become adversely impacted by the lack of compensation from avoiding "high-risk" cases, but might face a more severe financial impact if they have a higher mortality rating compared to their peers.
authors: Orlando Veterans Affairs Medical Center, Orlando, FL, USA University of Central Florida College of Medicine, Orlando, FL, USA adam.golden@ucf.edu.
authors: Adam G
authors: AG
authors: Golden
authors: West Palm Beach Veterans Affairs Medical Center, West Palm Beach, FL, USA.
authors: Michael A
authors: MA
authors: Silverman
authors: Orlando Veterans Affairs Medical Center, Orlando, FL, USA.
authors: Andrew
authors: A
authors: Heller
authors: BayCare Health System, Clearwater, FL, USA.
authors: Michael
authors: M
authors: Loyal
authors: University of Central Florida College of Medicine, Orlando, FL, USA.
authors: Juan
authors: J
authors: Cendan
mesh_terms: D000368:Aged; D016265:Conflict of Interest / Q000191:economics; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy; D017063:Outcome Assessment, Health Care; D016491:Peripheral Vascular Diseases / Q000209:etiology / Q000601:surgery*; D011183:Postoperative Complications; D011785:Quality Assurance, Health Care; D066231:Surgeons / Q000592:standards*; D013727:Terminal Care / Q000592:standards*
keywords: hospice; mortality; outcomes; physician rating; physician report cards; surgeon