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Factors That Influence the Choice to Undergo Surgery for Shoulder and Elbow Conditions

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related Research®

A CORR Insights to this article was published on 19 November 2013

Abstract

Background

Knowledge of the factors that influence the willingness of patients considering elective orthopaedic surgery is essential for patient-centered care. To date, however, these factors remain undefined in the orthopaedic population with shoulder and elbow disorders.

Questions/purposes

In a cohort of patients seeking surgical consultation for shoulder or elbow conditions, we sought to identify factors that influenced the willingness and decision to undergo surgery.

Methods

In this prospective study, 384 patients completed a questionnaire collecting socioeconomic and health status data before consultation from June 2009 to December 2010. An additional 120 patients who were offered surgery after consultation completed a second questionnaire on their perceptions and concerns regarding surgery. Logistic regression analyses were used to identify factors influencing the willingness and decision to undergo surgery.

Results

Lower income (odds ratio [OR], 0.02; CI, 0.02–0.08; p < 0.001) and living alone (OR, 0.25; CI, 0.08–0.77; p = 0.015) were negative predictors of willingness to consider surgery. Physical functioning did not influence willingness (p = 0.994). A greater perceived level of the likelihood of surgical success by the patient (OR, 41.84; CI, 5.24–333.82; p < 0.001) and greater fluency in the English language (OR, 28.39; CI, 3.49–230.88; p = 0.002) were positive predictors of willingness. Willingness to consider surgery as a possible treatment option before the consultation was a predictor of patients’ ultimate decisions to undergo surgery (OR, 4.56; CI, 1.05–19.76; p = 0.042). Patients expressing concern about surgery being an inconvenience to daily life, however, were less likely to decide to proceed with surgery (OR, 0.12; CI, 0.02–0.68; p = 0.017).

Conclusions

Many of the identified factors may act as barriers to potentially beneficial surgical interventions. Although most are not modifiable, an awareness of the influence of individual demographics and possible perceptions of patients’ choices may show that more in-depth questioning and provisions for cultural differences may be required during the consultation to enable patients to make fully informed decisions. Future studies using qualitative methods would provide a greater in-depth understanding of patients’ perceptions regarding surgery and their decision to proceed. Larger or more homogeneous cohorts also would enable additional identification of these factors for different shoulder and elbow conditions.

Level of Evidence

Level II, prognostic study. See the Instructions for Authors for a complete description of levels of evidence.

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Author information

Authors and Affiliations

  1. Division of Orthopaedic Surgery, Toronto Western Hospital, University Health Network, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada

    Chetan S. Modi MSc, FRCS (Tr&Orth), Christian J. H. Veillette MD, MSc, Rajiv Gandhi MD, MSc, Anthony V. Perruccio PhD & Y. Raja Rampersaud MD

Authors
  1. Chetan S. Modi MSc, FRCS (Tr&Orth)
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  2. Christian J. H. Veillette MD, MSc
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  3. Rajiv Gandhi MD, MSc
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  4. Anthony V. Perruccio PhD
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  5. Y. Raja Rampersaud MD
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Corresponding author

Correspondence to Christian J. H. Veillette MD, MSc.

Additional information

Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

Appendices

Appendix 1. Factors that influence the choice to undergo surgery: summary of preconsultation questionnaire*

What is the highest level of education you have completed?

What is the total annual household income (before taxes)?

What is your ethnicity?

How would you describe your ability to speak English?

What is your current living arrangement?

How willing are you to choose surgery as a treatment option?

How successful would surgery be for your condition?

How risky would surgery be for your condition?

  1. * Categorical options were provided for each question.

Appendix 2. Factors that influence the choice to undergo surgery: postconsultation questionnaire*

Do you have a good understanding of what happens to someone when they undergo surgery similar to what has been recommended for your condition?

How painful do you think the operative site would be after the specific surgery recommended for you?

For a person who has fully recovered from the specific surgery recommended for you, how limited do you expect she/he to be in their usual activities afterward?

I am concerned about / I have concerns about (please check all that apply):

  • Having surgery, going “under the knife”

  • Pain of surgery

  • Interference of surgery with my social activities

  • Inconvenience of surgery to my day-to-day life

  • Postoperative restrictions on mobility

  • About the risks of surgery

  • About whether I am a good candidate or not (considering my age, other health problems)

  • How much surgery will actually improve my condition

  • The timing of surgery

  • The place where either the surgery or rehabilitation will take place

  • My ability to cope with surgery and the recovery period because of my obligations to others (either family members, my employers, etc)

  • The competency of my surgeon (his or her experience with this procedure, etc)

  • The communication skills of my surgeon

Are you satisfied with the amount of say that you have had in making the decision to accept or deny surgery?

Please choose ONE of the 4 options below that you feel best reflects your thinking:

  • Yes, I’m ready to have surgery

  • I will/may consider having surgery at some time in the future but not now

  • I’m not sure about having this surgery

  • No I don’t want to have surgery (either now or in the future)

* Categorical options were provided for each question.

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Modi, C.S., Veillette, C.J.H., Gandhi, R. et al. Factors That Influence the Choice to Undergo Surgery for Shoulder and Elbow Conditions. Clin Orthop Relat Res 472, 883–891 (2014). https://doi.org/10.1007/s11999-013-3357-0

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  • DOI: https://doi.org/10.1007/s11999-013-3357-0

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