We thank Dr. Kaufman for his response to our recent article.1 He raises interesting and important points about discussions between clinicians and patients after a postoperative complication has occurred. Dr. Kaufman’s concerns seem to be predominantly about how best to disclose complications to patients, whereas the focus of our publication was on how best to discover complications. Dr. Kaufman has five specific concerns, which we will address sequentially, although several of the concerns fall outside the scope of our article. First, we agree that different clinicians might not agree on whether or not a complication has occurred. Indeed, this is borne out by our study, which found that three different methods yielded substantially different conclusions regarding a range of complications. The three bases for detecting complications in our study were (1) what is written in the medical record; (2) what is coded (e.g., International Classification of Diseases, Ninth Revision code) as a complication; and (3) what the patient reports as a complication. Second, Dr. Kaufman contends that there is no standard approach for explaining complications in the hand-off process. We agree with the sentiment and concur that developing standards would be helpful. Third, Dr. Kaufman expresses reservations about disclosing complications to patients in the hospital environment. We respectfully disagree with this perspective. Complications often have treatment implications and typically require compliance from patients and their families. For example, a patient who suffers a deep venous thrombosis, a wound infection, or a postoperative myocardial infarction will require specific follow-up, will need to take targeted medications, and might need to modify behavior. We believe that disclosing such complications in the hospital environment is mandatory; however, we agree that follow-up after hospital discharge can be very beneficial. Fourth, regarding who should disclose complications to our patients, we agree that all members of the healthcare team who have a stake in perioperative complications (including surgeons and anesthesiologists) should do this collaboratively. Although we agree with the fifth point that surveying patients’ family members regarding complications would likely yield valuable insights, ethical concerns regarding patient privacy and protected healthcare information make this challenging. It would also be logistically difficult.
Finally, and of particular relevance to our article, without knowing when our patients have experienced complications, we cannot appreciate our potential failings, and lack the necessary information to guide quality of care improvements. Thus, it is entirely appropriate and important for all clinicians, including anesthesiologists and surgeons, to track postoperative outcomes. On many occasions, information on complications can only be gleaned from patients’ reports. Based on our experience, our patients are pleased when we follow up with them to track their positive and negative outcomes, and increasingly they expect us to do this.
The authors declare no competing interests.