Exploring patient preferences for infrainguinal bypass operation

BACKGROUND: Surgical risk and outcomes for patients undergoing infrainguinal bypass operation vary by identifiable patient characteristics, yet little is known about whether patients understand the risks, benefits, and alternatives to operation. STUDY DESIGN: Cross-sectional surveys administered to 50 patients undergoing infrainguinal bypass operation at one institution an average of 7 days (median 4 days) before operations. RESULTS: Most patients rated their health as fair or poor (53%) or good (35%), and the majority reported their vascular disease was associated with difficulty doing activities they enjoyed (71%), leg pain (86%), and difficulty walking (98%). About one-half of patients (54%) thought they would require additional operations, 21% reported being at risk for postoperative myocardial infarction and 24% believed they would require a major amputation despite operations. Over two-thirds of patients (69%) believed their overall health would improve postoperatively, although more than four-fifths (80% to 86%) believed their ability to perform activities, leg pain, and walking would improve. Eighty-eight percent of patients reported willingness to have the operation even with a 10% postoperative mortality rate and 96% of patients reported a preference for operations if the chance of successful outcomes was only 75%. CONCLUSIONS: Although patients appear to be willing to undertake considerable postoperative risk, expectations for benefits from infrainguinal bypass operation appear greater than outcomes suggested by earlier research. These findings, if confirmed in larger studies, challenge how patient preferences should optimally be used to inform decisions about whether to undertake infrainguinal bypass operations. 2006 by the American College of Surgeons.