Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Aug 15;32(16):754-761.
doi: 10.5435/JAAOS-D-23-00656. Epub 2024 May 8.

Critical Portions of a Foot or Ankle Surgical Procedure From Patient and Surgeon Perspectives

Alexandra Flaherty  1 , Vasundhara Mathur, Nasser Heyrani, Gregory Waryasz, Daniel Guss, Soheil Ashkani-Esfahani, Christopher W DiGiovanni
Affiliations

Critical Portions of a Foot or Ankle Surgical Procedure From Patient and Surgeon Perspectives

Alexandra Flaherty et al. J Am Acad Orthop Surg. .

Abstract

Background: Over the past decade, overlapping procedures in orthopaedic surgery have come under increased public scrutiny. Central to this discussion is what should constitute a "critical portion" of any surgical procedure-a definition which may differ between patients and surgeons. This study therefore aimed to assess which components of three common foot and ankle procedures are considered "critical" from both the patient and surgeon perspectives.

Methods: For this survey-based study, questionnaires were administered to patients who presented to an orthopaedic foot and ankle clinic and separately administered to foot and ankle surgeons through e-mail. The questionnaires broached all steps involved in three common foot and ankle procedures: open reduction and internal fixation of ankle fracture, Achilles tendon repair, and ankle arthroscopy. Respondents were asked to characterize each step as "always critical," "often critical," sometimes critical," rarely critical," or "never critical." A combined "always critical" and "often critical" response rate of greater than 50% was used to define a step as genuinely critical. Patient and surgeon responses were thereafter compared using Mann-Whitney U and Kruskal-Wallis tests ( P -value <0.05 was considered significant).

Results: Notably, both patients and surgeons considered informed consent, preoperative marking of the surgical site, preoperative time-out, surgical soft-tissue dissection, and certain procedure-specific steps (critical portions) of these procedures. By contrast, only patients considered skin incision and wound closure to be critical steps.

Conclusion: Patients and surgeons were largely in agreement as to what should comprise the critical portions of several common foot and ankle procedures. Certain discrepancies did exist, however, such as skin incision and closure, and both groups were also in general agreement regarding what was not considered a critical component of these operations. Such findings highlight a potential opportunity for improved preoperative patient education and patient-physician communication.

Level of evidence: Level IV: Evidence from well-designed case-control or cohort studies.

PubMed Disclaimer

References

    1. Mitchell MB, Hammack-Aviran CM, Clayton EW, Langerman A: A survey of overlapping surgery policies at U.S. hospitals. J L Med Ethics 2021;49:64-73.
    1. Banks Susan, Becton Esperance, Cohen Allison, Mihalich-Levin Lori: Overlapping surgeries? All good. Concurrent surgeries? Not so much. Accessed at: https://www.jdsupra.com/legalnews/overlapping-surgeries-all-good-81183/ , Accessed February 4, 2023.
    1. Mello MM, Livingston EH: The evolving story of overlapping surgery. JAMA 2017;318:233-234.
    1. Zhang AL, Sing DC, Dang DY, et al.: Overlapping surgery in the ambulatory orthopaedic setting. J Bone Joint Surg Am Vol 2016;98:1859-1867.
    1. Perez AW, Brelsford KM, Diehl CJ, Langerman AJ: Surgeon perspectives on benefits and downsides of overlapping surgery: In-depth, qualitative interviews. Ann Surg 2021;274:e403-e409.