Measuring Decisional Regret in Orthopedic Surgery: Tools, Time Points, and Score Interpretation

As shared decision-making models gain prominence, patients are taking on more responsibility in deciding whether to undergo surgery. Decisional regret is a key patient-reported outcome (PRO) to evaluate quality of care and surgical success. With increased emphasis on decisional regret, determining the tools to measure regret is of increasing importance. The objectives of this study were to (1) investigate and identify the tools used to measure decisional regret in elective orthopedic surgery and (2) examine the time frame in which regret is measured postoperatively.

The authors conducted a systematic literature review of PubMed/MEDLINE and Embase databases from database inception until September 5, 2024. All studies that discussed a patient's decisional regret in the context of elective orthopedic surgery were eligible.

Initial results yielded 1,002 articles, and 26 were chosen for inclusion. The Decisional Regret Scale (DRS) was the most used tool, appearing in 54% of the articles. Novel, study-specific questions were used in 19% of the studies, while 15% used question 22 of the Scoliosis Research Society-22 tool and 11% used non-standardized patient interviews. Regret was assessed postoperatively at >24 months in 15% of studies, at 24 months in 17%, at 12 months in 22%, at 6 months in 26%, at multiple time frames in 4%, and was not stated in 8%.

Decisional regret is an increasingly important PRO that can help optimize medical interventions. The DRS, used in more than half of the studies analyzed, is the most widely adopted and validated tool for quantifying regret and should be prioritized in future research. While timing of regret assessment varied, the 6-month and 12-month postoperative intervals were the most common and are suggested as standard time points for measuring regret. Additionally, establishing clinical stratifications for regret scores will facilitate meta-analysis and improve risk factor identification, enhancing shared decision-making and patient care. [Orthopedics. 2025;48(4):e153-e161.].