title: Adult Spinal Deformity Patients Recall Fewer Than 50% of the Risks Discussed in the Informed Consent Process Preoperatively and the Recall Rate Worsens Significantly in the Postoperative Period.
abstract: METHODS
  Recall of the informed consent process in patients undergoing adult spinal deformity surgery and their family members was investigated prospectively.
  
  
  OBJECTIVE
  To quantify the percentage recall of the most common complications discussed during the informed consent process in adult spinal deformity surgery, assess for differences between patients and family members, and correlate with mental status.
  
  
  BACKGROUND
  Given high rates of complications in adult spinal deformity surgery, it is critical to shared decision making that patients are adequately informed about risks and are able to recall preoperative discussion of possible complications to mitigate medical legal risk.
  
  
  METHODS
  Patients undergoing adult spinal deformity surgery underwent an augmented informed consent process involving both verbal and video explanations. Recall of the 11 most common complications was scored. Mental status was assessed with the mini-mental status examination-brief version. Patients subjectively scored the informed consent process and video. After surgery, the recall test and mini-mental status examination-brief version were readministered at 5 additional time points: hospital discharge, 6 to 8 weeks, 3 months, 6 months, and 1 year postoperatively. Family members were assessed at the first 3 time points for comparison.
  
  
  RESULTS
  Fifty-six patients enrolled. Despite ranking the consent process as important (median overall score: 10/10; video score: 9/10), median patient recall was only 45% immediately after discussion and video re-enforcement and subsequently declined to 18% at 6 to 8 weeks and 1 year postoperatively. Median family recall trended higher at 55% immediately and 36% at 6 to 8 weeks postoperatively. The perception of the severity of complications significantly differs between patient and surgeon. Mental status scores showed a transient, significant decrease from preoperation to discharge but were significantly higher at 1 year.
  
  
  CONCLUSIONS
  Despite being well-informed in an optimized informed consent process, patients cannot recall most surgical risks discussed and recall declines over time. Significant progress remains to improve informed consent retention.
  
  
  METHODS
  3.
authors.affiliation: *Department of Neurological Surgery, University of California San Francisco, San Francisco, CA †University of California San Diego, School of Medicine, San Diego, CA ‡Department of Neurosurgery, University of Virginia Health System, Charlottesville, VA §Rocky Mountain Hospital for Children, Denver, CO ¶Department of Orthopaedic Surgery, Baylor Scoliosis Center, Plano, TX ‖Department of Orthopaedic Surgery, Oregon Health & Science University, Portland, OR **Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD ††Department of Orthopaedic Surgery, University of California, Davis, CA ‡‡Department of Orthopedic Surgery, University of California San Francisco, San Francisco, CA; and §§Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY.
authors.forename: Rajiv
authors.initials: R
authors.lastname: Saigal
authors.forename: Aaron J
authors.initials: AJ
authors.lastname: Clark
authors.forename: Justin K
authors.initials: JK
authors.lastname: Scheer
authors.forename: Justin S
authors.initials: JS
authors.lastname: Smith
authors.forename: Shay
authors.initials: S
authors.lastname: Bess
authors.forename: Praveen V
authors.initials: PV
authors.lastname: Mummaneni
authors.forename: Ian M
authors.initials: IM
authors.lastname: McCarthy
authors.forename: Robert A
authors.initials: RA
authors.lastname: Hart
authors.forename: Khaled M
authors.initials: KM
authors.lastname: Kebaish
authors.forename: Eric O
authors.initials: EO
authors.lastname: Klineberg
authors.forename: Vedat
authors.initials: V
authors.lastname: Deviren
authors.forename: Frank
authors.initials: F
authors.lastname: Schwab
authors.forename: Christopher I
authors.initials: CI
authors.lastname: Shaffrey
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Ames
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007258:Informed Consent / Q000523:psychology* / Q000706:statistics & numerical data*; D008297:Male; D011939:Mental Recall; D008875:Middle Aged; D011184:Postoperative Period; D011446:Prospective Studies; D011581:Psychological Tests; D012306:Risk; D013122:Spinal Diseases / Q000453:epidemiology* / Q000601:surgery*; D014741:Video Recording