Is a "Premonition" of Dying in Surgical Patients a Reason to Avoid Surgery? A Brief Review and Tentative Conclusions

While perioperative anxiety and depression are well-recognized in surgical patients, there is a long-standing, little-discussed, curious, but potentially concerning concept: that of the patient with a premonition that they will not survive the surgery. This phenomenon has seen variable interest since the 1960s, but its presence raises a concern for surgeons and worry about operating. After a brief review of the literature, it is concluded that the current literature is sparse and mainly descriptive in nature; no convincing evidence demonstrates that premonition of death predicts perioperative mortality, and surgical decision-making should not be altered based on the presence of such a premonition alone. However, we urge awareness by surgeons if such an attitude is present and, if so, it should not be ignored or minimized, but evaluated and treated, preferably in concert with a consulting psychiatrist, to optimize reassurance for patient, family, and the surgeon.