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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The Emerging Case for Shared Decision Making in Orthopaedics. JBJS

The Emerging Case for Shared Decision Making in Orthopaedics JBJS

This article nicely summarizes an Instructional Course Lecture from a recent meeting of the AAOS. It points to the virtually universal benefits of physician-patient shared decision making on one hand and the lack of widespread adoption of this approach on the other.  Shared decision making is also the topic of a recent article in CORR.

Much of what we do in orthopaedics is elective, so that there is time for patients to consider information about their diagnosis and treatment alternatives. This is important because the choices made are ‘preference-sensitive’ and the patient’s preference is heavily based on the information he or she considers.

As the article emphasizes, it is most helpful if patients receives quality information in advance of their visit with the surgeon so that (1) they may have time to review it at their leisure and discuss it with family and friends, (2) they may decide whether the trip to see the surgeon is timely or not, (3) they may be assured by the surgeon’s willingness to involve them in the process, (4) the time of their visit may be spent in dialogue rather than a uni-directional surgeon-to-patient information session, and (5) they may have time to prepare questions they’d like to ask at the visit.

As an example of an approach, we have attempted to use the Internet as a way of sharing decision aids, not only for patients, but also for physicians and the public. These aids include procedure descriptions (shoulder arthritis, total shoulder, ream and run, reverse total shoulder, CTA arthroplasty, and rotator cuff surgery). As pointed out by the authors, this saves time that would otherwise be spent fielding questions about surgical technique and perioperative care. These aids also include, as suggested by the authors of this article, testimonials and case histories from actual patients. Finally these aids also include review and commentary on the most recent relevant publications in the peer reviewed literature. The site also offers patients the opportunity to pose topics for future discussion on the blog. In this way we can avoid making patient-specific comments on one hand while offering generally applicable guidelines on the other. Internet based information cannot be misplaced and can be easily shared with friends or families located at a distance from the patient’s home. Our impression is consistent with that of the authors, “Patient activation increases adherence and improves outcomes.

While our efforts are still in their infancy, we are gratified that this blog continues to grow and now has over 10,000 page views per month from individuals worldwide. We hope that the information provided is informative and serves the purposes of shared decision making.

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If you have suggestions for topics you'd like us to address in this blog, please send an email to
shoulderarthritis@uw.edu.


Use the "Search the Blog" box to the right to find other topics of interest to you.

You may be interested in some of our most visited web pages including:shoulder arthritis, total shoulder, ream and run, reverse total shoulder, CTA arthroplasty, and rotator cuff surgery.


See the countries from which our readers come on this post.