Predictors of peri-operative risk acceptance by South African vascular surgery patients at a tertiary level hospital

Abstract

Background: Vascular surgical patients have an elevated cardiac risk following non-cardiac surgery. The decision whether to proceed with surgery is multidimensional. Patients must balance the considerations in favour of surgery with those favouring conservative treatment, which requires weighing peri-operative risk against morbidity associated with non-surgical treatment. Methods: The aim of this prospective correlational study was to determine the proportional contributions of (i) pain, (ii) impulsivity, (iii) patients' perception of the benefits of surgery, (iv) patients' perception of peri-operative risk and (v) the predicted peri-operative risk on acceptance of peri-operative risk by vascular surgical patients. Sixty patients were prospectively recruited by convenience sampling from the Inkosi Albert Luthuli Central Hospital vascular surgery clinic between April 2014 and June 2014. Written informed consent was obtained. Patients completed a questionnaire which documented demographics, pain assessment, impulsivity screen (Barratt Impulsiveness Scale 11), patients' perception of surgery, predicted peri-operative risk (South African Vascular Surgical Cardiac Risk Index) and acceptance of peri-operative risk. Data were analysed using descriptive statistics and linear regression (SPSS version 22). Results: The patients' perception of the benefits of surgery (β 0.36, 95% CI 0.14-0.70, p = 0.005) was the only predictor of peri-operative risk acceptance. The associations between the other potential predictors and the outcome were insignificant. Conclusion:The perceived benefit of surgery was the most important predictor of acceptance of peri-operative risk in this cohort.Keywords: pain, peri-operative risk, shared decision-making, vascular surgery There has been a global increase in the number of patients undergoing non-cardiac surgery with an estimated 500 000 to 900 000 patients experiencing peri-operative cardiac events annually. 1,2Vascular surgical patients have an increased cardiac risk following non-cardiac surgery and a high coexistent morbidity. The dilemma that these patients face involves balancing the risks and benefits associated with surgery against those of conservative management, which includes considering the peri-operative risk associated with the surgery (cardiac death, nonfatal myocardial infarction and nonfatal cardiac arrest) against the associated consequences without the surgery (intractable pain, limited mobility and death). 2−5Decision-making is a cognitive process that requires reflection on the consequences of a choice and deliberation on alternatives and contemplation of future outcomes. 6,7 Patient autonomy and readiness to give informed consent for surgery are affected by several factors. 8 The aim of this study was to determine the proportional contributions of (i) pain, (ii) impulsivity, (iii) patients' perception of the benefits of surgery, (iv) patients' perception of peri-operative risk and (v) predicted peri-operative risk on the acceptance of peri-operative risk by vascular sur...

Psychosocial Factors Are Associated With Risk Acceptance in Upper Extremity Patients

“…11,12,19 One study in people with peripheral vascular disease found no association between pain or limitations and risk acceptance. 20 The slight correlation between older age and risk acceptance is difficult to interpret, was inconsistent in prior studies, and may be spurious. A study of people with multiple sclerosis found the same small correlation with older age, 21 while studies of people considering spine and vascular surgery, and among people seeking care for gastrointestinal symptoms found no relationship to age 10,22,23 and studies of people with rheumatoid arthritis and health risk taking found less risk acceptance with older age.…”

The mediating role of pre‐operative patient readiness on surgical outcomes: A structural equation model analysis

“…Across studies, evidence suggests that patient characteristics, such as anxiety (Guo, 2014;Lucas, Cox, Perry, & Bridges, 2013;Pereira, Figueiredo-Braga, & Carvalho, 2016), health literacy (De Oliveira, McCarthy, Wolf, & Holl, 2015;Lin et al, 2014;Ortiz, Wang, Elayda, & Tolpin, 2015), surgical risk (Govender, Spurrett, & Biccard, 2015;Grocott, 2010;Levett, Edwards, Grocott, & Mythen, 2016), and type of surgery (Burkle et al, 2014;Ortiz et al, 2015), influence patient readiness, which in turn can influence surgical outcomes.…”

“…Across studies, evidence suggests that patient characteristics, such as anxiety (Guo, 2014; Lucas, Cox, Perry, & Bridges, 2013; Pereira, Figueiredo‐Braga, & Carvalho, 2016), health literacy (De Oliveira, McCarthy, Wolf, & Holl, 2015; Lin et al, 2014; Ortiz, Wang, Elayda, & Tolpin, 2015), surgical risk (Govender, Spurrett, & Biccard, 2015; Grocott, 2010; Levett, Edwards, Grocott, & Mythen, 2016), and type of surgery (Burkle et al, 2014; Ortiz et al, 2015), influence patient readiness, which in turn can influence surgical outcomes. Related surgical outcomes with a patient focus include perception of pain, postoperative analgesic consumption (Ali et al, 2014; Angioli et al, 2014; Wilson et al, 2015), patient experience or satisfaction (Greene et al, 2017; Guo, 2014), and complications (Ali et al, 2014; De Oliveira et al, 2015; Wilson et al, 2015).…”