How do surgeons' trade-off between patient outcomes and risk of complications in total knee arthroplasty? a discrete choice experiment in Australia

Sandie Szawlowski, Peter F.M. Choong, Jinhu Li, Elizabeth Nelson, Mandana Nikpour, Anthony Scott, Vijaya Sundararajan, Michelle M. Dowsey

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7 Citations (Scopus)

Abstract

Objective To 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). Methods A 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. Results The 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. Conclusion This 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.

Original languageEnglish
Article numbere029406
Number of pages11
JournalBMJ Open
Volume9
Issue number7
DOIs
Publication statusPublished - 1 Jul 2019
Externally publishedYes

Keywords

  • Discrete choice experiment
  • Joint replacement
  • Medical decision-making
  • Surgery

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