Risk acceptability assessment for complications of five orthopaedic procedures: a questionnaire based study

Abstract

Background Many orthopedic procedures are performed daily, and associated with these is always a risk of complications. A patient undergoing such a procedure must be aware of these risks. The process of informed consent is essential to achieve this. This study assessed the insight of patients close to the time of five orthopaedic procedures in our hospital. We undertook to determine the acceptable numeric thresholds for risk levels of complications of the five orthopaedic procedures that a patient may accept to give consent for a procedure. The knowledge gained will enable healthcare workers to provide better care, empower patients, and assist the judiciary system in better evaluating when dealing with malpractice cases. Objectives The study looked at what surgery-associated risk level a reasonable patient giving informed consent is willing to accept for five orthopaedic procedures. The study objectives were to determine the numeric risk threshold levels that are acceptable for each procedure and to describe the patients’ understanding of surgery-associated risks with the five orthopaedic procedures. Methods The research was a descriptive study in a questionnaire format conducted at a South African tertiary hospital. There were 230 participants in the study. They had all undergone one of five orthopaedic procedures. These included femur intramedullary nailing, tibia intramedullary nailing, ankle open reduction and internal fixation, distal radius open reduction and internal fixation, and hip arthroplasty. Descriptive and analytical statistics were used to analyse the collected data. Results Among the total of 230 study participants across all the five procedures mentioned above, there were 124 (53.91%) participants who accepted the risk levels of all complications as reported in the literature, while 106 (46.08%) of the participants did not accept the risk level of at least one or more complications as reported in the literature. Of this same group, there were 12 (11.32%) participants who would not accept the risk level of two or more complications as 3 reported in the literature. For the three complications shared among some of the procedures, namely, nerve injury, infection, and malalignment/ improper implant position, there was an overall high acceptance rate of the complication risk levels, as reported in the literature. The acceptance rate was 85% for nerve injury, 91% for infection, and 97% for malalignment/improper implant position. Within the hip arthroplasty, 93.75% (n = 30) of the participants accepted the complication risk level for death as reported in the literature. Conclusion Patients’ acceptability for the risk of the complications that can follow a surgical procedure is very important to evaluate. Almost 50% of patients who needed surgical intervention were not willing to accept the risks of one or more complications occurring with the procedure. This study has shown great variability in the acceptance levels of complication risks between the patients undergoing different orthopaedic procedures reviewed. The individualized informed consent process should be a gold standard to address the varied risk acceptance responses we found. This risk acceptance variability can be used to assist surgeons in individualizing the consent process and avoid unnecessary patient dissatisfaction and litigation.