Consent for spine surgery: an observational study

Area of Science:

• Neurosurgery
• Surgical Communication
• Patient Safety

Background:

• The ideal of informed consent in spine surgery contrasts with variable surgeon explanations and poor patient understanding.
• Current practice for informed consent in spine surgery is under-investigated.
• Patient interviews and surgeon surveys suggest a disconnect in the informed consent process.

Purpose of the Study:

• To investigate the reality of informed consent in spine surgery.
• To analyze risk/benefit discussions during informed consent for non-instrumented spine surgery.
• To provide an authentic reflection of current informed consent practices.

Main Methods:

• A prospective observational study at a single neurosurgical institution.
• Video recording of twelve informed consent consultations for non-instrumented spine surgery.
• Verbatim transcription and blind analysis using descriptive quantification and linguistic ethnography.

Main Results:

• Surgical benefit was discussed in 83% of consultations, but only 41% quantified its likelihood.
• Commonly discussed risks included nerve damage/paralysis (92%), bleeding (92%), and infection (92%).
• While surgeons often quantified risk (58%), only half of risks were explained in understandable terms.

Conclusions:

• Significant inconsistencies exist in how spine surgeons explain risks and obtain informed consent for common procedures.
• Disparities in informed consent provision may extend to other surgical specialties.
• Direct observation and qualitative analysis reveal limitations in current informed consent practices, guiding future improvements.