Sandiford Nemandra A, Mahendra Maalee, Wickramarachchi Lilanthi, Back Diane, Bansal Mohit
Joint Reconstruction Unit (Hip and Knee), Southland Teaching Hospital, Invercargill, NZL.
Orthopaedic Surgery, Guy's and St Thomas' Hospital, London, GBR.
Cureus. 2020 Jun 5;12(6):e8457. doi: 10.7759/cureus.8457.
Introduction The consenting process has been surgeon-focussed traditionally, but there is a recent trend towards making the process more patient and procedure-focussed. The primary aims were to identify the risks considered most important and requiring further discussion by the patients undergoing primary total hip arthroplasty (THA) and primary total knee arthroplasty (TKA), as well as to identify the sporting and recreational activities these patients would like to pursue after surgery according to the age group, taking into consideration their values and expectations. The secondary aim is to assess the compliance of the current consenting process with guidelines set out by a governing body in a tertiary referral arthroplasty unit. Material and method A prospective study reviewing the consenting process was carried out on 137 patients undergoing THA or TKA over a 12-month period in a tertiary teaching hospital. Patients unable to complete a questionnaire and undergoing revision or uni-compartment arthroplasty were excluded. A standardized anonymous questionnaire was administered. Patients were asked to fill in the specific activities they considered important to be discussed. The data were tabulated in Microsoft Excel (Microsoft Corporation, Redmond, Washington) and subgroup analysis was performed using the student's t-test. The level of statistical significance was p=0.05. Two-hundred consent forms were reviewed to assess whether the information entered correlated to the guidelines presented in Ortho-Consent. Results One-hundred thirty-seven questionnaires were reviewed. The mean age was 66 (range 45-91), with the majority of patients undergoing TKA (114) versus THA (23). The patients in active employment were more concerned about blood clots, pain, joint failure, limb length discrepancy, and infection. Patients undergoing TKA wanted more information on pain management and joint longevity, which achieved statistical significance. There was a significant difference in the activities patients would like to pursue as well as in expectations amongst different age groups. The quality of documentation in the consent form was quite variable in discussing complications, surgery benefits, and alternative treatments. Conclusion Obtaining consent is a patient-specific process. Patient perception of important points that merit discussion can vary with age and employment status. Return to driving is important for all ages, however, as the population ages, the ability to return to activities of daily living becomes an increasingly important discussion point during the consent process.
引言 传统上，同意手术的过程一直以外科医生为中心，但最近有一种趋势是使该过程更加以患者和手术为中心。主要目的是确定接受初次全髋关节置换术（THA）和初次全膝关节置换术（TKA）的患者认为最重要且需要进一步讨论的风险，以及根据年龄组确定这些患者术后希望从事的体育和娱乐活动，同时考虑他们的价值观和期望。次要目的是评估当前同意手术过程是否符合三级转诊关节置换科管理机构制定的指南。
材料与方法 在一家三级教学医院，对137例在12个月内接受THA或TKA手术的患者进行了一项回顾同意手术过程的前瞻性研究。无法完成问卷以及接受翻修手术或单髁关节置换术的患者被排除。发放了一份标准化的匿名问卷。要求患者填写他们认为重要且需要讨论的具体活动。数据在Microsoft Excel（微软公司，华盛顿州雷德蒙德）中制成表格，并使用学生t检验进行亚组分析。统计学显著性水平为p = 0.05。审查了200份同意书，以评估所填写的信息是否与《骨科同意书》中提出的指南相关。
结果 共审查了137份问卷。平均年龄为66岁（范围45 - 91岁），大多数患者接受TKA手术（114例），而接受THA手术的患者为23例。在职患者更关注血栓、疼痛、关节失效、肢体长度差异和感染。接受TKA手术的患者希望获得更多关于疼痛管理和关节寿命的信息，这具有统计学显著性。不同年龄组患者希望从事的活动以及期望存在显著差异。同意书中关于并发症、手术益处和替代治疗的记录质量差异很大。
结论 获得同意是一个因人而异的过程。患者对值得讨论的要点的认知可能因年龄和就业状况而异。恢复驾驶对所有年龄段都很重要，然而，随着人口老龄化，恢复日常生活活动的能力在同意手术过程中成为一个越来越重要的讨论点。
