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EVIDENCE BASED CONSENT FOR SHOULDER & ELBOW SURGERY – IS IT POSSIBLE AND HOW CAN IT BE ACHIEVED?

Nottingham Shoulder & Elbow Unit, Nottingham City Hospital, Nottingham, UK

The NHS Plan (2000) identified the need for change in the way patients are asked to give consent for surgery to make the process more explicit. A new NHS operation consent form was introduced in April 2002 following the Bristol enquiry into deaths associated with Cardiac Surgery.

Methods: We have addressed the obtaining of consent for surgery as an evidence-based exercise. The published literature has been reviewed and we have attempted to accurately quantify the success rates for surgery, complication rates and poor outcomes in order to identify what the likely benefits and risks are for our common operations –

1. Shoulder – Arthroscopic Sub-Acromial Decompression, Anterior stabilisation, Rotator Cuff repair, excision lateral end of clavicle and Shoulder Arthroplasty.
   
2. Elbow – Tennis elbow release, Arthroscopic Debridement, OK Operation and Elbow Replacement We became increasingly aware throughout this exercise that although there were many papers published; collating the relevant evidence based information for patients was either difficult or impossible.
   

Evidence was therefore been categorised into 4 levels:

1. National & International published results
   
2. Our own results, either published or presented at scientific meetings
   
3. Our own results as identified in internal audited outcome studies – unpublished
   
4. Our opinion of the risks or benefits unsupported by any scientific or published evidence.
   

Results: We have taken the standard NHS Consent Form and modified it in a printed format to present to the patient a clearer description of the anticipated outcome from their surgery (with percentages). This evidence based consent form was evaluated in a combined prospective and retrospective survey of 60 patients who attended our pre-operative assessment clinic. We will present the results of the survey and demonstrate the standardised Consent Forms.

Conclusions: The majority of the information the patient wished to know was Level 4 evidence!

The abstracts were prepared by Cormac Kelly. Correspondence should be addressed to The Secretary, British Elbow and Shoulder Society, Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London WC2A 3PE