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How do surgeons’ trade-off between patient outcomes and risk of complications in total knee arthroplasty? a discrete choice experiment in Australia
  1. Sandie Szawlowski1,
  2. Peter F M Choong2,3,
  3. Jinhu Li4,
  4. Elizabeth Nelson2,
  5. Mandana Nikpour5,
  6. Anthony Scott1,
  7. Vijaya Sundararajan6,
  8. Michelle M Dowsey2,3
  1. 1 Melbourne Institute of Applied Economic and Social Research, The University of Melbourne, Parkville, Victoria, Australia
  2. 2 Department of Surgery, St Vincent’s Hospital, The University of Melbourne, Fitzroy, Victoria, Australia
  3. 3 Department of Orthopaedics, St Vincent’s Hospital, Melbourne, Victoria, Australia
  4. 4 Department of Economics, Deakin University, Burwood, Victoria, Australia
  5. 5 Department of Medicine, St Vincent’s Hospital, The University of Melbourne, Fitzroy, Victoria, Australia
  6. 6 Department of Public Health, La Trobe University, Melbourne, Victoria, Australia
  1. Correspondence to Dr Michelle M Dowsey; mmdowsey{at}unimelb.edu.au

Abstract

Objective To measure the trade-off between risk of complications versus patient improvement in pain and function in orthopaedic surgeons’ decisions about whether to undertake total knee arthroplasty (TKA).

Methods A discrete choice experiment asking surgeons to make choices between experimentally-designed scenarios describing different levels of operative risk and dimensions of pain and physical function. Variation in preferences and trade-offs according to surgeon-specific characteristics were also examined.

Results The experiment was completed by a representative sample of 333 orthopaedic surgeons (n=333): median age 52 years, 94% male, 91% fully qualified. Orthopaedic surgeons were willing to accept substantial increases in absolute risk associated with TKA surgery for greater improvements in a patient’s pain and function. The maximum risk surgeons were willing to accept was 40% for reoperation and 102% for the need to seek further treatment from a general practitioner or specialist in return for a change from postoperative severe night-time pain at baseline to no night-time pain at 12 months. With a few exceptions, surgeon-specific characteristics were not associated with how much risk a surgeon is willing to accept in a patient undergoing TKA.

Conclusion This is the first study to quantify risk-benefit trade-offs among orthopaedic surgeons performing TKA, using a discrete choice experiment. This study provides insight into the risk tolerance of surgeons.

  • medical decision-making
  • discrete choice experiment
  • joint replacement
  • surgery

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Footnotes

  • Contributors SS was an investigator, conducted the literature search and statistical analysis, contributed to data interpretation and drafted and revised the paper. PC was a chief investigator, was involved in the design of the study, provided management oversight of the whole trial, contributed to data interpretation and drafted and revised the paper. JL was an investigator, wrote the statistical analysis plan, conducted statistical analysis, contributed to data interpretation and drafted and revised the paper. EN was the study coordinator, responsible for participant recruitment, provided technical support to participants, monitored data collection for the whole trial, drafted and revised the paper. MN and VS were chief investigators, designed the study, contributed to data interpretation and drafted and revised the paper. AS was a chief investigator, designed the study, provided management oversight over the statistical analysis, contributed to data interpretation and drafted and revised the paper. MD was the lead investigator, initiated the collaborative project, designed the study, monitored data collection for the whole trial, provided management oversight of the whole study, contributed to data interpretation, drafted and revised the paper and is the guarantor. All authors contributed to redrafts of the report. All authors had full access to the study data and take responsibility for the integrity of the data and the accuracy of the data.

  • Funding Financial support for this study was provided entirely by a grant from the National Health and Medical Research Grant Project, Grant no. APP1058438 (www.nhmrc.gov.au, nhmrc@nhmrc.gov.au, phone: +61 2 6217 9000). The funding agreement ensured the authors’ independence in designing the study, interpreting the data, writing and publishing the report.

  • Competing interests None declared.

  • Ethics approval This study was approved by the St. Vincent’s Human Research Ethics Committee (HREC-A 177/15).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No data are available.

  • Patient consent for publication Not required.

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