Skip to main content

Advertisement

SpringerLink
Log in

Consenting for risk in common ENT operations: an evidence-based approach

  • Miscellaneous
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Pre-operative consent discussion and documentation is an essential process that should follow relevant guidance, and include all serious or frequently occurring risks. We assessed the appropriateness of consent for grommet insertion, tonsillectomy, septoplasty, and hemithyroidectomy, by comparing the risks listed in current consenting practice to published complication data for the relevant operation. 120 consent forms and associated clinic letters were analysed. A literature search identified published complication data for comparison. There was great variation in consent practice for each operation type, and poor correlation with published risk incidence. Only ‘bleeding’ post-tonsillectomy and ‘recurrent laryngeal nerve injury’ post hemithyroidectomy were listed in 100 % of relevant cases. Common and serious complications were frequently omitted from forms. The number and type of risks consented for a procedure significantly differed between consultant and non-consultant staff. The potential requirement for blood transfusion was discussed in only 20 % of tonsillectomy cases. Currently, the pre-operative consent for commonly performed ENT operations does not reflect operative risks. Consenting for surgical complications should be evidence based using published or personal data. A change in the consent process is required to protect patient autonomy and meet both legal and professional body requirements.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Department of Health (2009) Reference guide to consent for examination or treatment, 2nd edn. Department of Health, London

    Google Scholar 

  2. The Royal College of Surgeons of England Good surgical practice (2008) The Royal College of Surgeons of England, London

  3. General Medical Council Consent: patients and doctors making decisions together (2008) General Medical Council, London

  4. Jeyaseelan L, Ward J, Papanna M, Sundararajan S (2010) Quality of consent form completion in orthopaedics: are we just going through the motions? J Med Ethics 36:407–408

    Article  PubMed  Google Scholar 

  5. Pearce ((1999) 48 BMLR 118) v United Bristol Healthcare NHS Trust

  6. deVries H et al (2009) International comparison of ten medical regulatory systems. RAND Corporation, Santa Monica

    Google Scholar 

  7. Code de Déontologie Médicale. http://www.conseil-national.medecin.fr/article/le-code-de-deontologie-medicale-915 Accessed 14 Mar 2013

  8. Professional code for physicians in germany. http://www.bundesaerztekammer.de/downloads/MBOengl.pdf Accessed 14 Mar 2013

  9. ENT-UK (2006) Clinical audit and practice advisory group. version of NICE Guidelines for pre-operative tests. ENT-UK, London

  10. Kay DJ, Nelson M, Rosenfeld RM (2001) Meta-analysis of tympanostomy tube sequelae. Otolaryngol Head Neck Surg 124:374–380

    Article  PubMed  CAS  Google Scholar 

  11. Browning GG, Rovers MM, Williamson I, Lous J, Burton MJ (2010) Grommets (ventilation tubes) for hearing loss associated with otitis media with effusion in children. Cochrane database of systematic reviews (online) doi:10.1002/14651858.CD001801.pub3

  12. National prospective tonsillectomy audit final report (2005) The Royal College of Surgeons of England, London

  13. Pinder DK, Wilson H, Hilton MP (2011) Dissection versus diathermy for tonsillectomy. Cochrane Database Syst Rev 16:CD002211

    Google Scholar 

  14. Evans AS, El-Hawrani A, Lodhi A, Thompson A (2003) Lip injury prevention during tonsillectomy. J Laryngol Otol 117:549–550

    Article  PubMed  CAS  Google Scholar 

  15. Bak NB (2010) Accidental tooth avulsion during tonsillectomy. Ugeskr Laeger 24:1611–1612

    Google Scholar 

  16. Heiser C, Landis BN, Giger R, Van Cao H, Guinand N, Hörmann K, Stuck BA (2010) Taste disturbance following tonsillectomy—a prospective study. Laryngoscope 120:2119–2124

    Article  PubMed  Google Scholar 

  17. Dhiwakar M, Clement WA, Supriya M, McKerrow W (2010) Antibiotics to reduce post-tonsillectomy morbidity. Cochrane Database Syst Rev 7:CD005607

    PubMed  Google Scholar 

  18. Randall DA, Hoffer ME (1998) Complications of tonsillectomy and adenoidectomy. Otolaryngol Head Neck Surg 118:61–68

    Article  PubMed  CAS  Google Scholar 

  19. Bateman ND, Woolford TJ (2003) Informed consent for septal surgery: the evidence-base. J laryngol otol 117:186–189. doi:10.1258/002221503321192476

    PubMed  CAS  Google Scholar 

  20. Vaiman M, Sarfaty S, Shlamkovich N, Segal S, Eviatar E (2005) Fibrin sealant: alternative to nasal packing in endonasal operations a prospective randomized study. Isr Med Assoc J 7:571–574

    PubMed  Google Scholar 

  21. The British Association of Endocrine and Thyroid Surgeons. Third National Audit Report (2009) BAETS, London. ISBN 1- 903968-25-9

  22. Wj C (2010) Fifteen years’ experience in thyroid surgery. Ann R Coll Surg Engl 92:541–547

    Article  Google Scholar 

  23. Keulers BJ et al (2008) Surgeons underestimate their patients’ desire for preoperative information. World J Surg 32:964–970

    Article  PubMed  CAS  Google Scholar 

  24. McManus PL, Wheatley KE (2003) Consent and complications: risk disclosure varies widely between individual surgeons. Ann R Coll Surg Engl 85:79–82

    Article  PubMed  CAS  Google Scholar 

  25. Beresford-Cleary NJ, Halliday J, Breusch SJ, Biant LC (2011) Consent process for elective total hip and knee arthroplasty. J orthop surg (Hong Kong) 19:274–278

    Google Scholar 

  26. Murphy K, Shafiq A, Corrigan MA, Redmond HP (2011) A descriptive study of consent documentation. Ir Med J 104:238–240

    PubMed  CAS  Google Scholar 

  27. British Medical Association (2009) Consent tool kit, 5th edn. British Medical Association, London

    Google Scholar 

  28. Chadha NK, Pratap R, Narula AA (2003) Consent processes in common nose and throat procedures. J Laryngol Otol 117:536–539

    Article  PubMed  Google Scholar 

  29. McDonald SE, Chadha NK, Mills RS (2008) Changing practices in the consent process for nose and throat procedures: a three-year study. J Laryngol Otol 122:1–4

    Article  Google Scholar 

  30. Puwanarajah P, McDonald SE (2010) Changes in surgical consent practices for common otolaryngology procedures: impact of modernising medical careers. J Laryngol Otol 124:899–904

    Article  PubMed  CAS  Google Scholar 

  31. Mistry D, Kelly G (2004) Consent for tonsillectomy. Clin Otolaryngol Allied Sci 29:362–368

    Article  PubMed  CAS  Google Scholar 

  32. Chester V, Afshar (2002). EWCA Civ 724; [2003] QB 356

  33. Code de la santé publique. http://www.legifrance.gouv.fr/affichCode.do;jsessionid=653363A8DA95AEB7D7AAC32C0C914E7B.tpdjo07v_2?cidTexte=LEGITEXT000006072665&dateTexte=20111108 Accessed 14 Mar 2013

  34. Molinelli A, Bonsignore A, Rocca G, Ciliberti R (2009) Medical treatment and patient decisional power: the Italian state of the art. Minerva Med 100:429–434

    PubMed  CAS  Google Scholar 

  35. The charter of fundamental rights of the european union. http://wwweuroparleuropaeu/charter/default_enhtm. Accessed 14 Mar 2013

  36. Simonsen AR, Duncavage JA, Becker SS (2010) A review of malpractice cases after tonsillectomy and adenoidectomy. Int J Pediatr Otorhinolaryngol 74:977–979

    Article  PubMed  Google Scholar 

  37. Stevenson AN, Myer CM 3rd, Shuler MD, Singer PS (2012) Complications and legal outcomes of tonsillectomy malpractice claims. Laryngoscope 122:71–74. doi:10.1002/lary.22438

    Article  PubMed  Google Scholar 

  38. Lavelle-Jones C, Byrne DJ, Rice P, Cuschieri A (1993) Factors affecting quality of informed consent. BMJ 306:885–890

    Article  PubMed  CAS  Google Scholar 

  39. Mahadevan D, Gupta S (2009) Consent for orthopaedic surgery: patient comprehension. Clin Gov 14:20e23

    Google Scholar 

Download references

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Department of Ear, Nose and Throat Surgery, Peterborough and Stamford Hospitals NHS Foundation Trust, Edith Cavell Campus, Bretton Gate, Peterborough, PE3 9GZ, UK

    M. E. Smith, R. Lakhani & N. Bhat

Authors
  1. M. E. Smith
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. R. Lakhani
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. N. Bhat
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. E. Smith.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Smith, M.E., Lakhani, R. & Bhat, N. Consenting for risk in common ENT operations: an evidence-based approach. Eur Arch Otorhinolaryngol 270, 2551–2557 (2013). https://doi.org/10.1007/s00405-013-2464-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00405-013-2464-6

Keywords

Search

Navigation