Utilization of a stepwise model to assess pivotal information for patient decision-making regarding open vs. arthroscopic Latarjet procedure

Abstract

Background: The popularity of arthroscopic Latarjet has increased significantly in recent years due to its perceived advantages. The latter include a smaller surgical incision, faster recovery, quicker return to sports, and ability to treat concomitant intra-articular pathology. Nevertheless, the arthroscopic technique is more technically challenging, has a more significant learning curve, longer operating time, and is less cost-effective. The study aimed to identify the various factors influencing patient decision-making between undergoing arthroscopic or open Latarjet using a stepwise questionnaire model.

Methods: All patients with a primary, whether arthroscopic or open Latarjet procedure were subjected to a stepwise interviewing process and were asked to select between arthroscopic and open approaches at each step.

Results: Fifty patients with a mean age of 28.8 ± 8.8 year old participated in the study. Twenty (40%) consistently selected an arthroscopic approach after analysis of the incision's aspect, whereas 34 (68%) had a final decision different from their initial choice. In addition, out of the 15 patients who chose arthroscopy or were undetermined after presentation of the incisional aspect, 9 (60%) changed their decision to open surgery after presentation of the pros and cons of each approach. Twenty-three (46%) patients were unable to choose and left the choice to their surgeon. The faith in their surgeon and recovery were identified as the 2 most important factors influencing patients' final decisions.

Conclusions: The minimally invasive nature of arthroscopic incisions was not considered to be more cosmetically appealing than that of a single open incision. The advantages of the arthroscopic procedure may not be as valued by patients as by surgeons. Patients were more interested in the equivalent short- and mid-term outcomes of both approaches and the shorter surgical duration of the open option. It is crucial to adequately inform patients during preoperative counseling to achieve the best consensus.

Keywords: Shoulder; complication; decision-making; glenohumeral instability; preoperative counseling; value-base healthcare.