Please Sign Here: Evaluating Differences Between Resident and Attending Informed Consent for Cholecystectomy

Please Sign Here: Evaluating Differences Between Resident and Attending Informed Consent for Cholecystectomy
Kathleen E. Singer, Jennifer E. Baker, Nora C. Elson, Taylor E. Wallen, Ann E. Salvator, Ralph Quillin, Jeffrey J. Sussman, Amy T. Makley, Michael D. Goodman
Journal of the American College of Surgeons, 1 November 2021; 233(5)
Open Access
Abstract
Introduction
There is considerable variability in surgeons’ approach to write and obtain informed consent for surgery, particularly among resident trainees. We analyzed differences in procedures and complications described in surgical consents for cholecystectomy between residents and attendings. We hypothesized that attending consents would list more comprehensive procedures and complications than those done by residents.
Methods
A retrospective analysis of 334 patients who underwent cholecystectomy at an academic tertiary care center was conducted. Charts were queried for demographics, surgical approach, whether the consent was completed electronically, and which provider completed the consent. Specifically, consents were evaluated for inclusion of possible conversion to open procedure, intraoperative cholangiogram, bile duct injury, injury to nearby structures, reoperation, bile leak, as well as if the consent matched the actual procedure performed.
Results
Of all consents analyzed, 46% included possible intraoperative cholangiogram, 47% included bile duct injury, 24% included injury to nearby structures, 7% included reoperation, and 20% included bile leak. In comparing residents and attendings, residents were more likely to consent for more possible complications and additional procedures, except for possible conversion to open and consenting for the complete procedure (Table 1). Junior residents were more likely than senior residents to include injury to nearby structures but senior residents were more likely to include reoperation.
Conclusion
Significant variation exists between resident and attending cholecystectomy consents, with residents including more complications than attendings on their consent forms. These data suggest that experience alone does not predict content of written consents, particularly for common ambulatory procedures.