title: Informed consent for abdominal aortic aneurysm repair: assessing variations in surgeon opinion through a national survey.
abstract: OBJECTIVE
  Informed consent discussions for elective abdominal aortic aneurysm (AAA) repair should reflect appropriate risks of the open or endovascular repair (EVAR), but few guidelines exist describing what surgeons should discuss. This study examines expert opinion regarding what constitutes informed consent.
  
  
  METHODS
  Design. We conducted an anonymous, web-based, national survey of vascular surgeons. Associations between surgeon characteristics and opinions regarding informed consent were measured using bivariate statistics; multivariable logistic regression was performed to estimate effects adjusted for covariates. Setting. Academic and private practice surgeons were surveyed. Subjects. United States members of the International Society for Vascular Surgery membership. Main Outcome Measure. Surgeons' self-reported opinions regarding the content of informed consent for AAA repair.
  
  
  RESULTS
  A total of 199 surgeons completed the survey (response rate 51%). More than 90% of respondents reported that it was essential to discuss mortality risk for both procedures. However, only 60% and 30% of respondents reported that it was essential to discuss the risk of myocardial infarction and stroke, respectively. Opinions varied by procedure regarding the risks of impotence (32% vs 62%; EVAR vs open repair), reintervention (78% vs 17%), and rupture during long-term follow-up (57% vs 17%). Younger and private practice surgeons were more likely to discuss complications compared with older surgeons and those in academic practice. Surgeons who perform predominantly EVAR were more likely to quote higher mortality rates for open repair (odds ration [OR] = 3.1, 95% confidence interval [CI] = 1.4-6.4) and lower reintervention rates for EVAR (OR = 0.3, 95% CI = 0.1-0.7) compared with other surgeons.
  
  
  CONCLUSIONS
  This is the first study of the practice of informed consent for AAA repair. The only risk that the vast majority of surgeons agreed should be included in informed consent for AAA repair was mortality. Significant variation exists regarding whether other complications should be discussed and what complication rates should be quoted. Surgeon characteristics may influence how risks are presented to patients. Further efforts are needed to develop guidelines to ensure consistent communication of appropriate risk during informed consent for AAA repair.
authors.affiliation: Yale University School of Medicine, New Haven, CT 06520, USA. loren.berman@yale.edu <loren.berman@yale.edu>
authors.forename: Loren
authors.initials: L
authors.lastname: Berman
authors.forename: Alan
authors.initials: A
authors.lastname: Dardik
authors.forename: Elizabeth H
authors.initials: EH
authors.lastname: Bradley
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Gusberg
authors.forename: Liana
authors.initials: L
authors.lastname: Fraenkel
mesh_terms: D000328:Adult; D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000150:complications / Q000401:mortality / Q000601:surgery*; D001019:Aortic Rupture / Q000209:etiology; D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D017558:Elective Surgical Procedures / Q000009:adverse effects; D007172:Erectile Dysfunction / Q000209:etiology; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007258:Informed Consent; D020407:Internet; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D016017:Odds Ratio; D010353:Patient Education as Topic; D010817:Physician-Patient Relations; D017410:Practice Guidelines as Topic; D012086:Reoperation; D018570:Risk Assessment; D020521:Stroke / Q000209:etiology; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014481:United States; D014656:Vascular Surgical Procedures / Q000009:adverse effects* / Q000401:mortality