VALID AND INFORMED CONSENT IN ORTHOPAEDIC SURGERY: A MULTICENTRE, REGIONAL SERVICE EVALUATION OF CURRENT UK PRACTICE.

Abstract

Background: In recent years, there has been increasing focus upon tailoring the consent process to reflect patients' individual needs and concerns. Meanwhile, clinical litigation costs for 'failure to warn' as part of 'informed consent' remain staggeringly high. We aimed to investigate the validity of the patient consent process in elective lower limb arthroplasty surgery regionally, with a view to ascertaining how it could be improved.

Methods: Regional data across the East of England was collected retrospectively from seven hospital trusts (fifty data sets per hospital) in 2021 and analyzed against predetermined criteria. Data analyzed included operation notes, patient records and clinic letters.

Results: A total of 165 elective knee and 173 elective hip replacement cases were included in the final analysis. Capacity criteria (defined as the ability to understand, retain, weigh up and communicate a decision) were fulfilled in 11.6% of hip and 13.9% of knee replacement surgeries, despite Consent Form 1 (a form commonly used in England to consent adults, deemed to have capacity, for surgical procedures) being completed in 94.8% and 88.5% of these same cases. Procedure-specific consent was obtained in 74.0% and 72.1% of cases, respectively, whilst 'Type' and 'Brand' of implant were rarely consented for. Alternative treatment options were offered in 67.1% of hips and 62.1% of knee cases. Separate consent clinics were offered in 55.5% of hip and 57.6% of knee cases.

Conclusions: This study demonstrates that there is room for improvement within the current consent process. We propose digitalization, utilizing interactive multimedia and audio-visual demonstrations to explain surgical procedures, as a dynamic and versatile adjunct to the consent process.