Joseph Nano Uncategorized

High‑Risk Surgery, Shared Decisions: New Zealand Clinic Helps Patients Choose Wisely—at Lower Cost

A prospective study from Tauranga Hospital (Aotearoa New Zealand) followed 81 high‑risk patients who attended a perioperative Complex Decision Pathway (CDP) clinic between 2019 and 2022. The clinic blends standard medical assessment with a structured Serious Illness Conversation (Aotearoa version) and a tikanga Māori framework to ensure care aligns with each person’s values. Just over half (52%) chose to proceed with surgery; 48% chose—or were advised—to avoid it. Participants were mostly older and frail with multiple conditions.

What stood out

  • Satisfaction stayed high for those who had surgery. Among patients who opted for surgery, 85% reported satisfaction with their decision at 6 months, and 80% at 12 months.
  • “No‑surgery” decisions were harder to live with—but often still felt right. In the group that avoided surgery, satisfaction was 38% at 6 months and 41% at 12 months; a minority expressed regret (3% at 6 months; 14% at 12 months).
  • Who chose what. Those advised not to have surgery were older on average (78.2 vs 73.5 years) and more often ASA class IV (23% vs 2%), reflecting higher baseline risk. Women were more likely to proceed with surgery (64% of the “yes” group).
  • Did surgery happen? Of those who intended to have surgery, 43% had undergone it by 6 months and 62% by 12 months.
  • Economics favored the clinic. Tallying operations that were considered but ultimately not done, the authors estimated ~NZ$1.26 million in avoided operative costs (≈NZ$32,326 per operation avoided). Running the clinic itself was estimated at ~NZ$66,792 per year (about 44 patients), suggesting the service is economically sustainable.

Why it matters

High‑risk operations carry uncertain benefits—and real harms. A clinic that slows down the decision, centers personal goals, and surfaces risk trade‑offs can steer patients toward choices they understand and stand by, while helping health systems use resources wisely. The authors note this was a single‑centre observational study during COVID‑disrupted years, so broader testing is warranted.

Source: Omundsen HC, Franklin RL, Omundsen MS, Richardson TR. “Experiences and outcomes of patients participating in a perioperative shared decision‑making pathway.” Anaesthesia and Intensive Care. 2025;53(1):25–36. doi: 10.1177/0310057X241265725.