#35861 A qualitative study of patients’ attitudes to awake orthopaedic surgery under regional anaesthesia

Abstract

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Background and Aims

Though awake surgery may minimise risk and reduce inpatient stays, uptake of awake surgery remains low. This qualitative study aimed to provide the baseline for future intervention development by identifying and characterising the qualitative barriers and drivers of awake surgery.

Methods

Post-operative semi-structured interviews using a 14-item interview were conducted with 19 people (12 females, seven males) undergoing day case orthopaedic surgery. Mean interview length was 34.8 minutes (SD 11.4 minutes). Interviews were transcribed verbatim and analysed using Thematic Analysis. Triangulation of themes generated high inter-rater agreement (96%).

Results

Two superordinate themes were identified: (1) Generation of anaesthetic preferences; and (2) Optimising pre-operative anaesthetic discussion. Strong preconceptions about the efficacy and appropriateness of general anaesthesia (GA) combined with pre-surgical online research to inform patient decision-making processes, were biased against regional anaesthesia (RA). Optimising the timing and content of pre-surgical anaesthetic consultations was felt to build rapport, elevate locus of control and increase satisfaction with care. Rushed, pressured conversations acted as barriers to RA uptake, risking patient disengagement and jeopardising informed consent. Developing rapport with the anaesthetist in advance of the day of surgery facilitated awake surgery willingness

Conclusions

The anaesthetic decision is highly personal and online research generated preconceptions, advantaging GA above RA. To facilitate informed decision-making, attention-diversion methods and engaged, patient-focused interpersonal clinical interactions acted as facilitators of awake surgery. This research demonstrated a novel area for patient-centred care enhancement: the need to optimise the timing, content and interpersonal dynamics involved in patient-anaesthetist interactions about RA.