TY - JOUR
T1 - How do surgeons' trade-off between patient outcomes and risk of complications in total knee arthroplasty? a discrete choice experiment in Australia
AU - Szawlowski, Sandie
AU - Choong, Peter F.M.
AU - Li, Jinhu
AU - Nelson, Elizabeth
AU - Nikpour, Mandana
AU - Scott, Anthony
AU - Sundararajan, Vijaya
AU - Dowsey, Michelle M.
N1 - Funding Information:
Funding Financial support for this study was provided entirely by a grant from the National Health and Medical Research Grant Project, Grant no. APP1058438 ( www.nhmrc.gov.au, [email protected], phone: +61 2 6217 9000). The funding agreement ensured the authors’ independence in designing the study, interpreting the data, writing and publishing the report.
Funding Information:
1Melbourne Institute of Applied Economic and Social Research, The University of Melbourne, Parkville, Victoria, Australia 2Department of Surgery, St Vincent's Hospital, The University of Melbourne, Fitzroy, Victoria, Australia 3Department of Orthopaedics, St Vincent's Hospital, Melbourne, Victoria, Australia 4Department of Economics, Deakin University, Burwood, Victoria, Australia 5Department of Medicine, St Vincent's Hospital, The University of Melbourne, Fitzroy, Victoria, Australia 6Department of Public Health, La Trobe University, Melbourne, Victoria, Australia Acknowledgements We acknowledge all the participants in the survey. We also acknowledge the surgeons, patients and other medical professionals who took part in the pre-testing phases and gave their time to the project. Associate Professor Michelle Dowsey holds an NHMRC Career Development Fellowship (APP1122526). Associate Professor Mandana Nikpour holds an NHMRC Career Development Fellowship (APP1126370). Professor Peter Choong holds an NHMRC Practitioner Fellowship (APP1154203). Dr Jinhu Li holds an ARC Discovery Early Career Researcher Awards (Project ID: DE170100829).
Publisher Copyright:
© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
PY - 2019/7/1
Y1 - 2019/7/1
N2 - 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.
AB - 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.
KW - Discrete choice experiment
KW - Joint replacement
KW - Medical decision-making
KW - Surgery
UR - http://www.scopus.com/inward/record.url?scp=85068723843&partnerID=8YFLogxK
U2 - 10.1136/bmjopen-2019-029406
DO - 10.1136/bmjopen-2019-029406
M3 - Article
C2 - 31272981
AN - SCOPUS:85068723843
SN - 2044-6055
VL - 9
JO - BMJ Open
JF - BMJ Open
IS - 7
M1 - e029406
ER -