Patient and Surgeon Risk-Taking Regarding Total Joint Arthroplasty

Published:December 21, 2021DOI:https://doi.org/10.1016/j.arth.2021.12.021

      Highlights

      • Compared risk-taking attitudes between patients considering arthroplasty & surgeons.
      • General risk-taking was similar between groups, except (marginally) in driving.
      • Also compared willingness to have/recommend surgery under different scenarios.
      • Patients were more willing than surgeons in lower-benefit higher-harm scenarios.
      • Patients were also more often indifferent between complication risks than surgeons.

      Abstract

      Background

      Decisions regarding care for osteoarthritis involve physicians helping patients understand likely benefits and harms of treatment. Little work has directly compared patient and surgeon risk-taking attitudes, which may help inform strategies for shared decision-making and improve patient satisfaction.

      Methods

      We surveyed patients contemplating total joint arthroplasty visiting a high-volume specialty hospital regarding general questions about risk-taking, as well as willingness to undergo surgery under hypothetical likelihoods of moderate improvement and complications. We compared responses from surgeons answering similar questions about willingness to recommend surgery.

      Results

      Altogether 82% (162/197) of patients responded, as did 65% (30/46) of joint replacement surgeons. Mean age among patients was 66.4 years; 58% were female. Surgeons averaged 399 surgeries in 2019. Responses were similar between groups for general, health, career, financial, and sports/leisure risk-taking (P > .20); surgeons were marginally more risk-taking in driving (P = .05). For willingness to have or recommend surgery, as the chance of benefit decreased, or the chance of harm increased, the percentage willing to have or recommend surgery decreased. Between a 70% and 95% chance of moderate improvement (for a 2% complication risk), as well as between a 90% and 95% chance of moderate improvement (for 4% and 6% complication risks), the percentage willing to have or recommend surgery was indistinguishable between patients and surgeons. However, for lower likelihoods of improvement, a higher percentage of patients were willing to undergo surgery than surgeons recommended. Patients were also more often indifferent between complication risks.

      Conclusion

      Although patients and surgeons were often willing to have or recommend joint replacement surgery at similar rates, they diverged for lower-benefit higher-harm scenarios.

      Keywords

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