How do surgeons’ trade-off between patient outcomes and risk of complications in total knee arthroplasty? a discrete choice experiment in Australia
| Autor: | Mandana Nikpour, Jinhu Li, Vijaya Sundararajan, Anthony Scott, Michelle M. Dowsey, Elizabeth Nelson, Sandie Szawlowski, Peter F. M. Choong |
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| Rok vydání: | 2019 |
| Předmět: |
Adult
Male joint replacement medicine.medical_specialty medical decision-making Joint replacement medicine.medical_treatment Clinical Decision-Making Total knee arthroplasty Discrete choice experiment Physical function Risk Assessment surgery 03 medical and health sciences Postoperative Complications 0302 clinical medicine Humans Medicine 030212 general & internal medicine Arthroplasty Replacement Knee business.industry Research 030503 health policy & services discrete choice experiment Australia Absolute risk reduction General Medicine Middle Aged Arthroplasty 3. Good health Orthopedics Treatment Outcome surgical procedures operative Orthopedic surgery Physical therapy Female Health Services Research 0305 other medical science Risk assessment business |
| Zdroj: | BMJ Open |
| ISSN: | 2044-6055 |
| Popis: | ObjectiveTo measure the trade-off between risk of complications versus patient improvement in pain and function in orthopaedic surgeons’ decisions about whether to undertake total knee arthroplasty (TKA).MethodsA discrete choice experiment asking surgeons to make choices between experimentally-designed scenarios describing different levels of operative risk and dimensions of pain and physical function. Variation in preferences and trade-offs according to surgeon-specific characteristics were also examined.ResultsThe experiment was completed by a representative sample of 333 orthopaedic surgeons (n=333): median age 52 years, 94% male, 91% fully qualified. Orthopaedic surgeons were willing to accept substantial increases in absolute risk associated with TKA surgery for greater improvements in a patient’s pain and function. The maximum risk surgeons were willing to accept was 40% for reoperation and 102% for the need to seek further treatment from a general practitioner or specialist in return for a change from postoperative severe night-time pain at baseline to no night-time pain at 12 months. With a few exceptions, surgeon-specific characteristics were not associated with how much risk a surgeon is willing to accept in a patient undergoing TKA.ConclusionThis is the first study to quantify risk-benefit trade-offs among orthopaedic surgeons performing TKA, using a discrete choice experiment. This study provides insight into the risk tolerance of surgeons. |
| Databáze: | OpenAIRE |
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