Patient factors in referral choice for total joint replacement surgery.
BACKGROUND
Although the option of next available surgeon can be found on surgeon referral forms for total joint replacement surgery, its selection varies across surgical practices.


OBJECTIVE
Objectives are to assess the determinants of (a) a patient's request for a particular surgeon; and (b) the actual referral to a specific versus the next available surgeon.


METHODS
Questionnaires were mailed to 306 consecutive patients referred to orthopedic surgeons. We assessed quality of life (Oxford Hip and Knee scores, Short Form-12, EuroQol 5D, Pain Visual Analogue Scale), referral experience, and the importance of surgeon choice, surgeon reputation, and wait time. We used logistic regression to build models for the 2 objectives.


RESULTS
We obtained 176 respondents (response rate, 58%), 60% female, 65% knee patients, mean age of 65 years, with no significant differences between responders versus nonresponders. Forty-three percent requested a particular surgeon. Seventy-one percent were referred to a specific surgeon. Patients who rated surgeon choice as very/extremely important [adjusted odds ratio (OR), 6.54; 95% confidence interval (CI), 2.57-16.64] and with household incomes of $90,000+ versus <$30,000 (OR, 5.74; 95% CI, 1.56-21.03) were more likely to request a particular surgeon. Hip patients (OR, 3.03; 95% CI, 1.18-7.78), better Physical Component Summary-12 (OR, 1.29; 95% CI, 1.02-1.63), and patients who rated surgeon choice as very/extremely important (OR, 3.88; 95% CI, 1.56-9.70) were more likely to be referred to a specific surgeon.


CONCLUSIONS
Most patients want some choice in the referral decision. Providing sufficient information is important, so that patients are aware of their choices and can make an informed choice. Some patients prefer a particular surgeon despite longer wait times.
*Department of Community Health Sciences, University of Calgary, Calgary, AB †Concordia Joint Replacement Group, University of Manitoba, Winnipeg, MB ‡Department of Orthopaedic Surgery, Dalhousie University, Halifax, NS §Concordia Hip and Knee Institute, Winnipeg, MB ∥Division of Orthopaedic Surgery, Dalhousie University, QEII Health Sciences Centre, Halifax, NS ¶Faculty of Medicine, University of Calgary, Calgary, AB, Canada.
Barbara L
BL
Conner-Spady
Deborah A
DA
Marshall
Eric
E
Bohm
Michael J
MJ
Dunbar
Lynda
L
Loucks
Allan W
AW
Hennigar
Cy
C
Frank
Tom W
TW
Noseworthy
D000368:Aged; D019643:Arthroplasty, Replacement / Q000523:psychology* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D008297:Male; D009985:Orthopedics / Q000592:standards / Q000706:statistics & numerical data; D057240:Patient Preference / Q000523:psychology* / Q000706:statistics & numerical data; D011788:Quality of Life; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D014850:Waiting Lists