Factors associated with decisional regret among patients undergoing major thoracic and abdominal operations

Abstract

No study has specifically investigated patient attitudes on decisional regret concerning major operative procedures. The objective of the present study was to define the prevalence of regret among patients who had undergone a major abdominal or thoracic operative procedure and to identify factors associated with postoperative regret. Decisional regret was assessed using the validated Decision Regret Scale, which consisted of 5 items with Likert-scale responses. Data on preoperative decision-making preferences and postoperative regret, quality of life, and symptoms of anxiety and depression were collected and analyzed. Overall, 157 (68.9%) patients agreed to participate and completed the survey, while 12 (5.3%) patients declined citing lack of time or interest. The types of operative procedures varied, with 65 (41.7%) patients undergoing a thoracic operation, 59 (37.8%) resection of the pancreas, liver or bile duct, and 32 (20.5%) patients having a colorectal/enteric operation. Although most patients (n=98, 62.4%) expressed no degree of regret, a subset of patients did; specifically, 59 (37.6%) patients conveyed a varied degree of postoperative regret, with 20 (12.7%) patients expressing a moderate degree of regret, and 13 patients (8.3%) experiencing substantial regret. Postoperative regret was associated with a history of postoperative complications (odds ratio 4.7, 95% confidence interval 1.2-17.7, P<.01) and with discordance between a patient's preferred and actual perceived decision-making role (odds ratio 5.3, 95% confidence interval 1.6-17.4, P<.01). Patients experiencing regret were 5 times more likely than patients not experiencing regret to demonstrate borderline or abnormal depression scores (odds ratio 5.4, 95% confidence interval 1.6-18.0, P<.01); anxiety scores directly correlated with regret (rho 0.254, P<.01). Patient-reported decisional regret after major abdominal and thoracic operations was present in 37% of patients, with roughly 1 in 12 patients reporting substantial regret and distress over the decision to have undergone operation. Discordance between patients' preferred and actual involvement in operative decision-making was associated with postoperative regret, as was poor quality of life, anxiety, and depression.