Discordance between surgeon opinion and institutional policy on explant handling after hardware removal

Hardware removal is a common procedure performed by orthopaedic surgeons, yet there is not a consensus on the disposition of explanted hardware. There seems to be increasing discordance between institutional policy and surgeon or patient preference. The purpose of this study was to gain insight on hardware removal polices across North America and determine surgeons' opinions regarding the return of orthopedic fixation devices to patients and if these opinions are related to surgeon-specific demographic factors.

A voluntary Qualtrics Survey was created and distributed to orthopedic surgeons with a self-identified substantial practice in trauma. Survey items included information about the surgeon's practice, hospital hardware removal policy, and personal opinion on institutional explant management. We also sought to evaluate variability in hospital policy among different geographic regions and types of hospitals/institutions.

One hundred forty-two surgeons met inclusion criteria for this survey. 88 % of respondents believe that patients should be entitled to keep their explanted hardware. Years in practice, frequency of hardware removal procedures, and subspecialty were not correlated with surgeon opinion. 66 % of hospitals have a policy allowing patients to keep their explanted hardware. There was no correlation between hospital policy and region or type of institution.

While 88 % of surgeons believe that patients should be allowed to keep their explanted hardware, only 66 % of hospitals currently allow this practice. Despite the clear consensus among orthopedic surgeons, hospital policy across North America is not standardized and does not correlate with the opinions held by the majority of surgeons.