Friday, November 29, 2013

Factors that influence patients to have shoulder and elbow surgery

Factors That Influence the Choice to Undergo Surgery for Shoulder and Elbow Conditions.

This is an interesting study of the willingness of patients to consider elective shoulder or elbow surgery.

A greater perceived level of the likelihood of surgical success by the patient, greater fluency in the English language, and willingness to consider surgery before consultation were positive predictors of the patient's ultimate willingness to consider surgery.

The authors found that lower income, living alone, and concern about surgery being an inconvenience to daily life were negative predictors of willingness to consider surgery. The authors viewed these as "barriers to potentially beneficial surgical interventions".

We suggest that the critical question is not whether the patient is willing to have surgery, but rather a better question is whether surgery is appropriate for this patient. As surgeons we can vary our "pitch" so that surgery sounds more or less attractive to the patient. It seems to us each of the 'negative' predictors of willingness may actually be negative predictors of outcome. For example, see Risk factors for readmission of orthopaedic surgical patients which was a retrospective cohort study of 3264 orthopaedic surgical admissions during two fiscal years. The authors concluded that marital status, Medicaid insurance status, and race may indicate how a patient's social and economic resources can impact his or her risk of being readmitted to the hospital.

Maybe a patient's 'unwillingness' is an appropriate barrier that we should not try to talk him or her out of. Maybe a non-English speaking man without substantial means, living alone in a mountain cabin who is worried about the effect on his ability to get along is not a good candidate for a reverse total shoulder, even if he has bad rotator cuff tear arthropathy. Elective surgery is elective for appropriate candidates. See here.

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