Do surgeons postpone offer of discretionary surgery when patients are experiencing difficult life events?

Aims and objectives: There is substantial surgeon-to-surgeon variation in offering discretionary surgery. Part of this variation may relate to awareness of, and sensitivity to, mental and social health priorities. This survey-based experiment randomized features of patient scenarios to measure the relative association of a patient's difficult life event (DLE) in the last year on surgeon decision to (1) delay consideration of discretionary surgery and (2) suggest prioritizing mental and social health with appropriate referral.

Methods: We invited hand and upper extremity surgeon members of the Science of Variation Group to review six scenarios of patients considering discretionary surgery for de Quervain tendinopathy, lateral epicondylitis, trapeziometacarpal arthritis, wrist osteoarthritis, non-displaced scaphoid wrist fracture and displaced partial articular radial head fracture and 106 participated. The following aspects of the scenarios were randomized: gender, age, symptoms and limitations, socioeconomic status, feelings of worry and despair regarding symptoms, and experience of a DLE in the last 12 months. Multi-level logistic regression was used to seek patient and surgeon factors associated with offer of operative treatment now (vs. postponing) and formal referral for counselling.

Results: Accounting for potential confounders, surgeons were less likely to offer discretionary surgery to patients who experienced a DLE in the last year, women and non-trauma diagnosis. Surgeon referral for mental and social health support was associated with disproportionate symptom intensity and magnitude of incapability, notable symptoms of worry or despair and a DLE in the last year.

Conclusion: The observation that a recent DLE is associated with surgeon delay in offer of discretionary surgery reflects that surgeons may prioritize mental and social health in this context.