Shanley B Deal, MD1, Jennifer A Rich, BS2, Elizabeth Carlson, MD1, Guillaume S Chevrollier, MD2, Michael J Pucci, MD2, Adnan A Alseidi, MD, EdM1. 1Virginia Mason Medical Center, 2Sidney Kimmel Medical College of Thomas Jefferson University
INTRODUCTION: Surgeons often assume patients may be dissatisfied if their operation were stopped due to suspicious intraoperative findings or injury requiring transfer of care. Knowledge of patient centered opinions may help clarify how patients feel when these situations arise to support patient safety. We sought to assess patient opinions regarding transfer of care for unexpected intraoperative findings during laparoscopic cholecystectomy with and without bile duct injury, and whether these perceptions may differ.
METHODS AND PROCEDURES: The investigators developed two clinical scenarios comparing transfer of care for unexpected intraoperative findings during elective laparoscopic cholecystectomy (without bile duct injury and with injury requiring open repair). A multi-institutional structured telephone interview process was conducted with patients ≥18 years of age who had an outpatient, uncomplicated laparoscopic cholecystectomy within the last year. The first scenario presented a case of suspicious findings prompting the surgeon to stop and transfer for specialized care; whereas, the second case was a bile duct injury requiring transfer of care. Textual and thematic analysis, as well as descriptive statistics, were used to analyze our interview results.
RESULTS: Forty-five patients were contacted and completed the survey. Satisfaction with transfer of care for unexpected intraoperative findings without bile duct injury was 69% and over 95% of respondents were satisfied their surgeon stopped the procedure to initiate transfer due to safety concerns; 64% of patients would return to that surgeon for post operative care and 78% would see that surgeon for another operation in the future. In the scenario with bile duct injury requiring open repair, 86% were satisfied with their surgeon’s decision to stop the operation, 91% of patients were satisfied with transfer of care, and 32% would see their first surgeon again in the future. Themes of prioritizing safety, providing explanations, appreciation for admission of error and setting aside ego were frequently cited in both scenarios.
CONCLUSIONS: Patients prioritize safety and are highly satisfied with halting a procedure to facilitate transfer of care for suspicious intraoperative findings during routine laparoscopic cholecystectomy. The majority would return to that surgeon for surgical care.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 86548
Program Number: P128
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster