To the Editor. —
The report by Hosking et al1 raises some perplexing questions about the adequacy and application of survival-based studies that fail to include data about patients' quality of life. As the researchers point out, surgical outcomes, in terms of increased longevity for patients, continue to improve. At the same time, concerns about rising medical care costs, allocation of critical care beds and other valuable resources, and what constitutes medically futile treatment have entered the realm of medical decision making. The bind, so elegantly demonstrated in and by this study, is that medicine (and here more specifically surgery) can keep patients living longer; but by leaving out functional data from the study design, the implication is that these data are not important in ultimately evaluating whether survival is a positive or negative goal.
Phipps EJ. The Outcome of Surgery in Patients More Than 90 Years Old. JAMA. 1989;262(7):900. doi:10.1001/jama.1989.03430070048016
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