Predictors of Peri-Operative Risk Acceptance by South African Vascular Surgery Patients at a Tertiary Level Hospital

Abstract

Background: Vascular surgical patients have an elevated cardiac risk following non-cardiac surgery. The decision whether to proceed with surgery is multidimensional. Patients must balance the considerations in favour of surgery with those favouring conservative treatment, which requires weighing peri-operative risk against morbidity associated with non-surgical treatment.

Methods: The aim of this prospective correlational study was to determine the proportional contributions of (i) pain, (ii) impulsivity, (iii) patients’ perception of the benefits of surgery, (iv) patients’ perception of peri-operative risk and (v) the predicted peri-operative risk on acceptance of peri-operative risk by vascular surgical patients. Sixty patients were prospectively recruited by convenience sampling from the Inkosi Albert Luthuli Central Hospital vascular surgery clinic between April 2014 and June 2014. Written informed consent was obtained. Patients completed a questionnaire which documented demographics, pain assessment, impulsivity screen (Barratt Impulsiveness Scale 11), patients’ perception of surgery, predicted peri-operative risk (South African Vascular Surgical Cardiac Risk Index) and acceptance of peri-operative risk. Data were analysed using descriptive statistics and linear regression (SPSS version 22).

Results: The patients’ perception of the benefits of surgery (β 0.36, 95% CI 0.14–0.70, p = 0.005) was the only predictor of peri-operative risk acceptance. The associations between the other potential predictors and the outcome were insignificant.

Conclusion: The perceived benefit of surgery was the most important predictor of acceptance of peri-operative risk in this cohort.

Keywords: Pain, Peri-operative Risk, Shared Decision-making, Vascular Surgery