Predictors of willingness to undergo elective musculoskeletal surgery

Rajiv Gandhi,^1,2 Anthony V Perruccio,^1,3 Y Raja Rampersaud<sup>1,2

1</sup>Division of Orthopaedic Surgery, Toronto Western Hospital, University Health Network, ²Department of Surgery, Faculty of Medicine, University of Toronto, ³Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada


Purpose: Knowledge of what influences patients’ willingness to undergo elective orthopedic surgery is vital to the patient shared decision-making process. We sought to document the prevalence and identify the predictors of unwillingness to undergo surgery among a cohort of hip/knee, foot/ankle, neck/back, and hip/knee patients.
Patients and methods: Patient demographics and information on patient health status, perceptions of risk and success of surgery, and willingness to undergo surgery were collected. Sequential logistic regression models were used to investigate the influence of the captured variables on willingness to undergo surgery.
Results: Overall, 392 (20%) of 1946 participants reported being unwilling to undergo or unsure about undergoing (“unwilling/unsure”) surgery if it was offered to them. From adjusted analyses, low income and non-White ethnicity were associated with a greater likelihood of being unwilling/unsure. Compared with hip/knee patients, neck/back patients were more likely to report being unwilling/unsure (odds ratio: 1.90 [95% confidence interval: 1.36, 265]); no differences were found between the remaining anatomical groups. However, when perceptions of risk and success were additionally considered, the influence for the neck/back cohort was significantly attenuated. Foot/ankle and elbow/shoulder patients were found to be significantly less likely to report unwillingness when perceptions were considered.
Conclusion: In addition to demographic/economic influences, perceptions of surgical risk and success play a critical role in patients’ willingness to undergo surgery.

Keywords: risk perception, orthopedic surgery, patient perceptions, ethnicity