Department of General Surgery, University of Cincinnati, Cincinnati, Ohio.
Department of General Surgery, University of Cincinnati, Cincinnati, Ohio.
J Surg Educ. 2022 Nov-Dec;79(6):1509-1515. doi: 10.1016/j.jsurg.2022.07.021. Epub 2022 Aug 24.
There is considerable variability in surgeons' approach to write and obtain informed consent for surgery, particularly among resident trainees. We analyzed differences in procedures and complications described in documented surgical consents for cholecystectomy between residents and attendings. We hypothesized that attending consents would describe more comprehensive procedures and complications than those done by residents.
This is a retrospective analysis of 334 patients who underwent cholecystectomy. Charts were queried for demographics, surgical approach, whether the consent was completed electronically, and which provider completed the consent. Specifically, consents were evaluated for inclusion of possible conversion to open procedure, intraoperative cholangiogram, bile duct injury, injury to nearby structures, reoperation, bile leak, as well as if the consent matched the actual procedure performed.
This study was conducted at an accredited general surgery training program at an academic tertiary care center in the Midwest.
This was a review of 334 patients who underwent cholecystectomy over a 1 year period.
Of all documented consents analyzed, 153 (47%) specifically included possible intraoperative cholangiogram, 156 (47%) included bile duct injury, 76 (23%) included injury to nearby structures, 22 (7%) included reoperation, and 62 (19%) included bile leak. In comparing residents and attendings, residents were more likely to consent for bile duct injury (p = 0.002), possible intraoperative cholangiogram (p = 0.0007), injury to nearby structures (p < 0.0001), reoperation (p < 0.0001), and bile leak (p < 0.0001).
Significant variation exists between documentation between resident and attending cholecystectomy consents, with residents including more complications than attendings on their consent forms. These data suggest that experience alone does not predict content of written consents, particularly for common ambulatory procedures. Education regarding the purpose of informed consent and what should be included in one may lead to a reduction in variability between providers.
外科医生在书写和获取手术知情同意方面存在相当大的差异，特别是在住院医师培训生中。我们分析了住院医师和主治医生记录的胆囊切除术手术同意书中描述的手术过程和并发症的差异。我们假设主治医生的同意书会比住院医师的同意书更全面地描述手术过程和并发症。
这是一项对 334 名接受胆囊切除术患者的回顾性分析。病历中记录了患者的人口统计学资料、手术方法、同意书是否通过电子方式完成以及由哪位医生完成了同意书。具体而言，评估了同意书是否包括可能转为开放手术、术中胆管造影、胆管损伤、邻近结构损伤、再次手术、胆漏等，并检查同意书是否与实际进行的手术相符。
这项研究是在中西部一家学术性三级保健中心的认证普通外科培训项目中进行的。
这是对一年内接受胆囊切除术的 334 名患者进行的回顾性分析。
在分析的所有记录的同意书中，有 153 份（47%）特别包括了可能的术中胆管造影，156 份（47%）包括胆管损伤，76 份（23%）包括邻近结构损伤，22 份（7%）包括再次手术，62 份（19%）包括胆漏。在比较住院医师和主治医生时，住院医师更有可能同意胆管损伤（p=0.002）、可能的术中胆管造影（p=0.0007）、邻近结构损伤（p<0.0001）、再次手术（p<0.0001）和胆漏（p<0.0001）。
住院医师和主治医生的胆囊切除术同意书的文件记录存在显著差异，住院医师在同意书中记录的并发症比主治医生多。这些数据表明，经验本身并不能预测书面同意书的内容，尤其是对于常见的门诊手术。关于知情同意的目的和应包含内容的教育可能会减少提供者之间的差异。
