Lightning Podiums: Spinal Potpourri - 803B

Presented by: K. Bhanot

Author(s):

K. Bhanot(1), E. Crawford(1), G. Rosenberg(2), A. Yee(1,3)

(1) University of Toronto, Department of Surgery, Division of Orthopaedic Surgery, Toronto, ON, Canada
(2) Sunnybrook Health Sciences Centre, Toronto, ON, Canada
(3) Sunnybrook Health Sciences Centre, Department of Orthopaedic Surgery, Toronto, ON, Canada

Abstract

Aim: Informed consent is a critical tenet of the physician-patient relationship. We hypothesize that there is significant clinical practice variation (CPV) in the consent process discussion between surgeons and their patients. We standardized a routine single-level lumbar microdiscectomy surgical case in order to determine the extent of CPV that exists amongst practicing spine surgeons in Canada.

Methods: An established framework for surgical complications in routine posterior lumbar single level spinal microdiscectomy was utilized. A cross-sectional survey was administered to Canadian Spine Society members with surgical expertise with this procedure. Fifteen routinely- identified surgical risks were surveyed and graded as "commonly, uncommonly, rarely or not routinely discussed" by surgeons. A biostatistician compared results comparing spinal specialties, type of clinical practice (i.e. academic versus community), years in practice, and surgeon experience in the number of consent discussions.

Results: An average of 3.6 (24%) out of 15 complications were "not routinely discussed" by surgeons surveyed. Interestingly, "wrong level surgery" was a complication not discussed by 59.2% (29/49) respondents, lower than we anticipated. Additionally, orthopaedic surgeons were more likely to discuss fewer complications (4.1/15; 27.3%) as compared to their neurosurgical counterparts (2.2/15; 14.7%; p=0.03). Poisson multi-variable regression considering surgeon and practice factors indicated that surgeon specialty (neurosurgeons compared to orthopaedic surgeons, p=0.02) and the experience in number of consent discussions (< 50 versus < 50, p=0.03, and < 50 versus 100, p=0.006) were statistical predictors. Orthopaedic surgeons were more likely to discuss fewer complications compared with neurosurgeons, and physicians with more experience obtaining consents were also more likely to discuss fewer complications.

Conclusions: There is significant CPV in the individual risks discussed during the formal informed consent process. The results of this study highlight the importance of considering CPV. Surgeon background training and their experience with informed consents appear to be predictive of potential complications that may be discussed with patients. Although we recognize that in many situations individualization of informed consent is required because of patient and anatomic factors, in this survey we did standardize a "routine" clinical scenario for which there still appears to be significant CPV.