Occasionally during surgery, an additional abnormality is found which is unrelated to the condition for which the procedure is being undertaken. While uncommon, such findings highlight the limitations of pre-operative…
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When surgeons carrying out an operation incidentally find an unrelated problem, should they go ahead and treat this too during the same surgery or wait for another time until having discussed it with the patient, and obtaining consent for further surgery if still required? This question was asked of New Zealand surgeons and those in training to see what they thought were the important things to consider and what they would do in different circumstances such as whether it was an emergency, whether the extra surgery could lead to serious complications or if it avoided another operation. The results showed that surgeons vary in what they emphasised but made decisions that reflected a sensible approach. It would be easier to make these decisions if there was a discussion between patient and surgeon beforehand prompted in the surgical consent process.
Sometimes during an elective surgical procedure, an abnormality is found which is unrelated to the scheduled procedure. In many instances, immediate treatment of this unexpected pathology is in the patient’s medical interests, however, specific patient consent has not been obtained. This study investigates current surgical practice when confronted by an incidental finding (IF), as well as surgeons’ views on informed consent in this context.
An online survey was sent to all practicing surgeons and surgical trainees within New Zealand. Respondents were presented with hypothetical scenarios involving IFs and asked to decide whether or not they would proceed with treatment. Opinion was sought on the factors influencing such decisions and the need for a clause within surgical consent documents to prompt discussion about IFs.
151/450 (33.6%) surgeons and trainees responded. Immediate treatment was more likely with IFs of greater clinical significance, lower-risk procedures and where there was prior consent for IF treatment. A proportion of surgeons did not follow these trends. Although a great deal of variation exists in the way that IFs are dealt with in the consent process, the majority of respondents (111/129, 86%) favoured a clause within a consent form that prompts discussion and seeks consent for the treatment of IFs.
Responses to the IF scenarios were generally consistent with good practice. While variation in decision-making is to be expected, some decisions were concerning. Most surgeons agree that a clause within the consent form should trigger a discussion of IFs during the consent process.