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Transatlantic consensus of vascular surgery consent
Mark E. O'Donnell, MD FRCS1, Cristine Velazco, MD2, Ryan Day, MD2, Damian McGrogan, MB MRCS1, William M. Stone, MD2, Richard J. Fowl, MD2, Bernard Lee, FRCS1, Michael G. Wyatt, MD FRCS3, Carolyn Pence-Smith, BA2, Samuel R. Money, MBA MD2.
1Royal Victoria Hospital, Belfast, United Kingdom, 2Mayo Clinic, Phoenix, AZ, USA, 3Freeman Hospital, Newcastle upon Tyne, United Kingdom.
OBJECTIVES:
Currently, there are no explicit guidelines for informed consent for vascular surgical interventions. The objective of this study was to compare current peer-practice and collate transatlantic consensus relating to vascular surgery patient consent.
METHODS:
A prospective anonymous online survey was administered to members of the Society for Clinical Vascular Surgery (SCVS) and the Vascular Surgical Society of Great Britain and Ireland (VSS). Each member evaluated general and procedural specific complications for both arterial and venous interventions which should be discussed with patients during the informed consent process. Greater than 75% reporting for a specific complication was deemed the threshold for consensus opinion.
RESULTS:
Overall response rate was 24.8%. The majority of respondents were attending surgeons (81.5% SCVS vs. 85.2% VSS). Both societies considered senior trainees competent to obtain consent. The majority of patients were consented primarily by the attending (67.6% SCVS vs. 90.6% VSS, p<0.01) on a pre-printed consent form (95.1% SCVS vs. 98.7% VSS). Consent was obtained on the day of surgery in the office (35.4%-SCVS) or the day before surgery in the hospital ward (35.1%-VSS) with the provision of additional written documentation (59.2% SCVS vs. 85.4% VSS, p<0.01). Both societies concurred with documentation of general arterial and venous complications including bleeding, cardiac, cerebrovascular, respiratory, thromboembolic and wound infection as well as more specific complications pertaining to aortic aneurysm, carotid endarterectomy, lower limb bypass, amputation and venous surgeries. Figure 1 delineates post-operative advice to patients provided by SCVS and VSS respondents with inclusion of a 75% consensus limit. Although the VSS reported a significantly higher consent training rate (14.1% SCVS vs. 40.8% VSS, p<0.01), both societies stated this mainly involved ad-hoc informal training.
CONCLUSIONS:
Whilst completion logistics of vascular consent vary, both SCVS and VSS members concur on the majority of complications necessary for inclusion in informed vascular consent. However, a formal consent training process for junior surgeons is warranted.
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