Our Summary

This research paper discusses how risk aversion, or the tendency to avoid risk, can be an unintended result of public health care reporting. The paper discusses four potential outcomes from this risk aversion:

  1. High-risk patients may be denied certain treatments.
  2. Innovation may be discouraged.
  3. Unnecessary or ineffective treatments might be avoided more.
  4. High-risk patients may be matched with more capable healthcare providers.

The authors look at evidence from cardiovascular medicine and surgery, as most observations about risk aversion come from these fields. They note that risk aversion does seem to happen, but the evidence is more consistent and convincing in the field of interventional cardiology (a branch of cardiology that deals specifically with the catheter-based treatment of heart diseases) than in cardiac surgery.

FAQs

  1. What is risk aversion in the context of healthcare public reporting?
  2. What are some of the possible consequences of risk aversion in cardiac surgery?
  3. Does empirical data suggest risk aversion is more prevalent in interventional cardiology or cardiac surgery?

Doctor’s Tip

One helpful tip a doctor might tell a patient about cardiac surgery is to follow all pre-operative instructions provided by the medical team, including fasting before the surgery, taking medications as directed, and avoiding certain activities. This can help reduce the risk of complications during and after the surgery. It is also important to have a thorough discussion with the surgeon about the procedure, potential risks, and expected outcomes. Being well-informed and prepared can help the patient feel more confident and have a smoother recovery process.

Suitable For

Patients who are typically recommended for cardiac surgery are those with severe coronary artery disease, valvular heart disease, congenital heart defects, or aortic aneurysms. These patients may have symptoms such as chest pain, shortness of breath, fatigue, or palpitations, and may have already tried other treatments such as medications or lifestyle changes without success. They may also have other risk factors such as diabetes, high blood pressure, or a family history of heart disease. Ultimately, the decision to recommend cardiac surgery is based on a careful evaluation of the patient’s overall health, the severity of their condition, and the potential benefits and risks of the procedure.

Timeline

Before cardiac surgery:

  1. Patient undergoes diagnostic tests such as echocardiogram, stress test, and coronary angiography to determine the need for surgery.
  2. Patient is evaluated by a cardiac surgeon and anesthesiologist to assess the risks and benefits of surgery.
  3. Patient may undergo pre-operative procedures such as blood tests, chest X-ray, and electrocardiogram.
  4. Patient may receive counseling on the procedure, potential risks, and post-operative care.

After cardiac surgery:

  1. Patient is transferred to the intensive care unit immediately after surgery for close monitoring.
  2. Patient is gradually weaned off mechanical ventilation and other life support measures.
  3. Patient begins physical therapy and rehabilitation to regain strength and mobility.
  4. Patient is discharged from the hospital and continues recovery at home.
  5. Patient may need to attend follow-up appointments with the cardiac surgeon and cardiologist for monitoring and medication management.

What to Ask Your Doctor

  1. What are the specific risks and benefits of the proposed cardiac surgery procedure for my individual case?
  2. How many times have you performed this particular surgery, and what is your success rate?
  3. Are there alternative treatment options available for my condition, and what are their risks and benefits compared to surgery?
  4. What is the expected recovery time and rehabilitation process after the surgery?
  5. What are the potential complications or side effects of the surgery, and how are they typically managed?
  6. Will I need any follow-up procedures or medications after the surgery?
  7. How long will I need to stay in the hospital after the surgery, and what kind of support will I need at home during the recovery period?
  8. Are there any lifestyle changes or restrictions I will need to follow after the surgery to improve my long-term outcomes?
  9. What is the long-term prognosis for my condition after undergoing this surgery?
  10. Are there any specific questions or concerns I should discuss with a cardiac surgeon or other healthcare professionals before making a decision about the surgery?

Reference

Authors: Shahian DM, Jacobs JP, Badhwar V, D’Agostino RS, Bavaria JE, Prager RL. Journal: Ann Thorac Surg. 2017 Dec;104(6):2093-2101. doi: 10.1016/j.athoracsur.2017.06.077. Epub 2017 Nov 1. PMID: 29100643