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  • Making decisions about major surgery

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    Tim Stephens is a researcher at Queen Mary University of London and Barts Health NHS Trust and a qualified intensive care nurse. He is currently working with a large team of clinicians, patients and scientists to investigate how older people make decisions about having major surgery. 

    In this blog, Tim talks about shared decision-making, individual impact and the need for better data to help clinicians quantify risk. 


    Let’s imagine that you’re in your early 70s and you have a few chronic health problems. Your mobility has been getting worse due to arthritis in your hip. You’ve tried pain killers, had some physiotherapy and now use a stick but the pain and restriction in your function is getting you down. Your GP refers you to your local hospital to see an orthopaedic surgeon to discuss surgery. How do you know if having surgery is the right decision for you?

    On the face of it the decision may seem easy; have the surgery to cure the problem. Indeed many, or even most of us, would choose this option to be rid of the pain. What, however, about the short- and long-term risks of surgery? We know that with increasing age, and in particular with increasing number of chronic health problems, the medical risks associated with surgery increase. That is to say, the surgical procedure, the hip replacement itself, may go smoothly but the overall process of surgery, anaesthesia and hospitalisation may make existing medical problems worse or create new ones. This is a situation that hundreds of older people face each week in the UK, and as the population ages and advances in medicine and surgery increase, will become even more common. However, quantifying these risks has been a major challenge for researchers to date.

    The Optimising Shared Decision Making In high RIsk Surgery (OSIRIS) research programme is funded by the National Institute of Health Research (NIHR). We’re focussing on the group of older patients who often have significant chronic health issues and are at greater risk of complications around and after surgery. We’re asking some big questions about how these patients and their doctors currently make decisions about major surgery and how we could improve that process. We are also looking at the data on over 5 million patients to truly understand what happens to older patients in the year after surgery. This will then allow us to develop a tool to forecast and present risks associated with surgery. This will be tested in a trial across UK hospitals, to see if it improves the decisions people make.

    Presenting a more detailed risk forecast to patients will help them to understand how the choice about surgery may specifically impact them and their lives and so support genuine shared decision-making. Surgery improves the lives of millions of people a year around the world, but it is not without risks and patients and doctors need to be more aware of these and be able to discuss them openly. The outputs of the OSIRIS research programme will help increase that awareness and allow people to make informed decisions where all the risks can be weighed up against all the benefits.

    Shared decision making and informed consent are hot topics right now in the health care professions and in the media. We’re 2 years into our 6-year research programme and we already know so much more about the decision-making process and how we might improve this. Ultimately, doctors need access to better, more individualised information and patients need to be presented this information in a way that is clear and comprehensible. We are very hopeful that OSIRIS will provide a model to empower patients to make a major decision that is right for them. Watch this space!

    You can find out more about the research by visiting the OSIRIS Programme website or following @osirisprogramme on Twitter.

    If you'd like to share your thoughts on any of the issues raised in the blog or another patient safety topic, please get in touch with Patient Safety Learning by emailing content@pslhub.org or leave a comment below. 

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    I am going through this now!
    i know your article is primarily for major surgery but i think it works for any surgical procedure!  I have pre-existing conditions/disabilities, some autoimmune. As a result, I am considered, “high risk” for Covid-19. While the cases and deaths continue to rise, uncontrollably...          I have been staying home as much as possible. 
    Before Covid, my Carpal Tunnel had started to come back (after 15+ years of no CT pain). My Neurologist did a Nerve Conduction test and the results were not good! He told me to contact the Orthopedic Surgeon, to set a date for surgery (to prevent further damage and hopefully to alleviate some symptoms). Eventually he agreed to give me 1 steroid injection and told me to schedule surgery when the shot wears off. 
    Long story short...The pain has come back, with a vengeance! But I don’t feel 100% safe to have surgery during this crazy Covid madness! I’d like to wait till the “second wave,” is more controlled! Unfortunately, he said he won’t prescribe anything for my pain and numbness, in the meantime. Not even a non-narcotic med that I requested, that has worked successfully for me in the past! He gave me 0 options and not much hope, as he is basically forcing me to have the surgery now. I wish I could share this article with him!

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