Patient Attitudes Regarding High-Risk Low-Volume Surgery

Area of Science:

• Health Services Research
• Patient-Reported Outcomes
• Surgical Quality Measurement

Background:

• Controversy exists regarding "Take the Volume Pledge" and using surgical volume as a quality surrogate.
• Limited data available on patient attitudes towards volume-based care initiatives.
• Need to understand patient preferences for healthcare location and influencing factors.

Purpose of the Study:

• To examine patient preferences and perceptions regarding healthcare location.
• To identify factors influencing patient decisions on where to receive surgical care.
• To assess patient risk tolerance concerning hospital/surgeon volume and outcomes.

Main Methods:

• Prospective study at a tertiary military hospital (2018-2019).
• Anonymous preoperative questionnaires administered to patients across specialties.
• Univariate and multivariable analyses to identify predictors of referral desire; risk tolerance assessed.

Main Results:

• 1.5% of 603 patients desired referral to a high-volume subspecialist.
• Key predictors for referral: perceived displeasure with care (P=.02) and lack of input in decision-making (P=.04).
• Most patients accepted lower volume (57.6%), increased complication risk (49.8%), and decreased survival (55.3%) to stay local.

Conclusions:

• Few patients desire referral to high-volume centers; patient preferences are paramount.
• Open discussion and shared decision-making are critical for patient choice in surgical location.
• Patients often prioritize local care, accepting higher risks and lower volumes, highlighting the need to study patient preferences.