Decisional Regret Among Patients Undergoing Colectomy

Abstract

BACKGROUND: Patients undergoing colectomy may be at risk for postoperative regret, which is associated with worse quality of life, higher rates of depression, and poorer health outcomes. A better understanding of factors associated with decisional regret may allow surgeons to better tailor preoperative discussions to mitigate the risk of regret. OBJECTIVE:This study aimed to identify factors associated with regret in patients undergoing elective and urgent/emergent colectomy. DESIGN:A retrospective cohort study. SETTING:The Michigan Surgical Quality Collaborative, a 73-hospital collaborative, which collects clinical data on general surgery operations.PATIENTS: Patients aged >18 years who underwent elective or urgent/emergent colectomy between January 2017 and March 2020 and who completed a decision regret survey. MAIN OUTCOME MEASURES:Any degree of postoperative regret. RESULTS:Of 3638 patients, 2,530 (70%) underwent elective and 1108 (30%) underwent urgent/emergent colectomy. Overall, 381 (10.5%) patients reported regret, with higher rates among the urgent/emergent setting compared with the elective cohort (13.0% vs 9.4%; p < 0.001). In the elective cohort, regret was associated with length of stay >7 days (OR, 2.32; 95% CI, 1.06-5.07), postoperative complication (OR, 1.95; 95% CI, 1.36-2.79), and readmission (OR, 1.90; 95% CI, 1.22-2.95). Elective colectomies for cancer/adenoma/polyp were associated with lower odds of regret (OR, 0.68; 95% CI, 0.50-0.91). In the urgent/emergent cohort, regret was associated with female sex (OR, 1.69; 95% CI, 1.15-2.50) and nonhome discharge destination (OR, 1.61; 95% CI, 0.04-1.03).LIMITATIONS: Hospitals used different sampling strategies, limiting our ability to calculate a true response rate and characterize nonresponders. CONCLUSIONS:One in 10 patients reported regret after colectomy with higher rates in those undergoing urgent/ emergent colectomy. Factors associated with regret were different between surgical settings. Efforts are needed to mitigate patients' risk of regret with individualized discussions contingent on surgical settings to better align expectations and outcomes.

Shared decision‐making and social science: A patient perspective

“…Developing additional analogous mechanisms to help patients with complex diseases learn, understand the roles of different members of the team, the communication patterns and appropriate behaviours and expectations of a patient, would make the journey smoother as well as facilitate SDM. Better SDM and information could also reduce decision regret after surgery [34]. The benefits of helping patients become experts in their disease could further spill over to the broader medical community, whereby these patients then engage in impactful social media and contribute to future research [35].…”

The impact of intestinal stoma formation on patient quality of life after emergency surgery—A systematic review

“…Forty-five full text papers were assessed, with a total of 15 papers included from this method. One further paper was identified from the reference and citation lists of the included papers (a total of 753 potential articles were identified and screened via this method), yielding a total of 16 papers for inclusion in the final systematic review (Figure 1) [27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42].…”