Presurgical Information Research Articles

Painful experience in adolescents undergoing surgical correction of scoliosis.

The aim of our study is to learn about the post-surgical pain experience in adolescents undergoing surgical correction of Adolescent Idiopathic Scoliosis (AIS). Qualitative study with an interpretative phenomenological approach. Through semi-structured interviews, 7 informants, women aged between 12 and 21, were interviewed between the third and fifth day after being surgically treated for AIS correction. The speeches were recorded and transcribed verbatim. Content Analysis method was used to analyse the discourse. The categories established were: influential factors, values and ideas, coping mechanisms and improvement areas. Painful experience is a determining factor during recovery, influenced by the individuals themselves, as well as by the support received, and the environment. Their main values and ideas about the process are based on pre-surgical information, which they consider insufficient. In order to cope, they use of distraction, relaxation and drug consumption. According to the informants, increasing the information they are given about the process, facilitating visits and incorporating complementary techniques would improve pain control. Pain is the main focus of the process and is influenced by several factors. The patients' coping mechanisms help in its management. They also put forward different improvement areas.

Decisional regret and choice of breast reconstruction following mastectomy for breast cancer: A systematic review.

Women facing mastectomy for breast cancer should have the option of considering whether they would like breast reconstruction (BR), and if so, what type and when. Previous research has demonstrated that some women will come to regret their decision about BR. We aim to summarise the evidence about the prevalence of decisional regret (DR) associated with BR choices and identify factors influencing vulnerability to DR. A systematic review of the literature reporting BR-related DR published between January 1994 and February 2017 identified 254 initial search results. Thirteen publications from 12 studies (5672 participants) met the selection criteria and were included in the final review. Each article was allocated a quality score out of 24. Overall, DR levels were reported as low and stable, although direct comparison across studies was limited by inconsistencies in measurement and reporting methods. Estimates of DR scores ranged from 9.3/100 to 5.4/20. All studies identified a relationship between higher levels of DR and an insufficient amount, inadequate quality, or unclear nature of information provided to women prior to undergoing mastectomy. A major determinant of DR was new or recurrent cancer, while psychosocial characteristics including depression, distress, and negative body image increased the likelihood of DR. The available research is yet to provide a clear understanding of the many interrelated issues involved in DR. Given the consensus that presurgical information was inadequate, making standardised educational material more widely available and increasing use of breast care nurses in preoperative patient education roles may be useful.

MRI of the Hip: What the Surgeon Wants to Know

The purpose of this review is to explore novel MR imaging techniques focused on the hip as well as specific MR imaging findings of interest to the referring orthopedic surgeon. MR arthrography demonstrates high accuracy for the detection of chondrolabral lesions, which portend less favorable prognosis and may change surgical approach. The addition of leg traction has been shown to increase the accuracy of MR arthrography in detecting intra-articular pathology. 3D models of the hip generated from 3D imaging sequences can also be used for pre-surgical planning, including simulation of preoperative range of motion. Extra-articular pathology, including hamstring, gluteal, and iliopsoas tendon pathology can necessitate surgical intervention depending on the degree of injury. MR arthrography remains the imaging modality of choice in assessment of the hip when intra-articular pathology is clinically suspected, though conventional MR imaging at 3.0 T also demonstrates strong diagnostic performance. New techniques including direct traction and 3D imaging can provide valuable diagnostic and pre-surgical information in the assessment of the athlete’s hip.

Automated femoral landmark extraction for optimal prosthesis placement in total hip arthroplasty.

The automated extraction of anatomical reference landmarks in the femoral volume may improve speed, precision, and accuracy of surgical procedures, such as total hip arthroplasty. These landmarks are often hard to achieve, even via surgical incision. In addition, it provides a presurgical guidance for prosthesis sizing and placement. This study presents an automated workflow for femoral orientation and landmark extraction from a 3D surface mesh. The extraction of parameters such as the femoral neck axis, the femoral middle diaphysis axis, both trochanters and the center of the femoral head will allow the surgeon to establish the correct position of bony cuts to restore leg length and femoral offset. The definition of the medullary canal endosteal wall is used to position the prosthesis' stem. Furthermore, prosthesis alignment and sizing methods were implemented to provide the surgeon with presurgical information about performance of each of the patient-specific femur-implant couplings. The workflow considers different commercially available hip stems and has the potential to help the preoperative planning of a total hip arthroplasty in an accurate, repeatable, and reliable way. The positional and orientation errors are significantly reduced, and therefore, the risk of implant failure and subsequent revision surgery are also reduced.

Intratumoral and Intertumoral Genomic Heterogeneity of Multifocal Localized Prostate Cancer Impacts Molecular Classifications and Genomic Prognosticators

BackgroundNext-generation sequencing is revealing genomic heterogeneity in localized prostate cancer (CaP). Incomplete sampling of CaP multiclonality has limited the implications for molecular subtyping, stratification, and systemic treatment. ObjectiveTo determine the impact of genomic and transcriptomic diversity within and among intraprostatic CaP foci on CaP molecular taxonomy, predictors of progression, and actionable therapeutic targets. Design, setting, and participantsFour consecutive patients with clinically localized National Comprehensive Cancer Network intermediate- or high-risk CaP who did not receive neoadjuvant therapy underwent radical prostatectomy at Roswell Park Cancer Institute in June–July 2014. Presurgical information on CaP content and a customized tissue procurement procedure were used to isolate nonmicroscopic and noncontiguous CaP foci in radical prostatectomy specimens. Three cores were obtained from the index lesion and one core from smaller lesions. RNA and DNA were extracted simultaneously from 26 cores with ≥90% CaP content and analyzed using whole-exome sequencing, single-nucleotide polymorphism arrays, and RNA sequencing. Outcome measurements and statistical analysisSomatic mutations, copy number alternations, gene expression, gene fusions, and phylogeny were defined. The impact of genomic alterations on CaP molecular classification, gene sets measured in Oncotype DX, Prolaris, and Decipher assays, and androgen receptor activity among CaP cores was determined. Results and limitationsThere was considerable variability in genomic alterations among CaP cores, and between RNA- and DNA-based platforms. Heterogeneity was found in molecular grouping of individual CaP foci and the activity of gene sets underlying the assays for risk stratification and androgen receptor activity, and was validated in independent genomic data sets. Determination of the implications for clinical decision-making requires follow-up studies. ConclusionsGenomic make-up varies widely among CaP foci, so care should be taken when making treatment decisions based on a single biopsy or index lesions. Patient summaryWe examined the molecular composition of individual cancers in a patient's prostate. We found a lot of genetic diversity among these cancers, and concluded that information from a single cancer biopsy is not sufficient to guide treatment decisions.

Analysis of T2 signal intensity helps in the differentiation between high and low-grade brain tumours in paediatric patients

Previous studies hypothesized that the analysis of magnetic resonance intensity of the solid portion in paediatric tumours can provide pre-surgical information about the histopathology. Classically, high signal-intensity in T2weighted (T2w) images identifies low-grade tumours, while anaplasia is characterized by T2 hypointensity. We aimed to investigate if T2w signal intensities can pre-operatively distinguish between low-grade and high-grade brain tumours in paediatric patients. Two raters, blinded to the histological diagnosis, rated the signal intensity of MR images (T2w) from 36 children with newly diagnosed brain tumours, 17 children with low-grade brain tumours and 19 children with high-grade brain tumours were included in this study. Relative T2 values were obtained by dividing the T2w values of the solid portion of the tumour by the T2w values of the vitreous humour. The best cut-off point to distinguish low and high-grade paediatric brain tumours was 0.8. If the signal intensity was less than or equal to 0.8 the tumour was expected to be a high-grade tumour with a sensitivity of 100%. Prediction of a low-grade tumour was more uncertain with a sensitivity of 70.5%. Overall, 86% of the tumours would have been predicted correctly. Our data suggest that T2w signal intensities of the solid portion of brain tumours in paediatrics can pre-operatively differentiate between low-grade and high-grade tumours. In addition, T2 hypointensity may be helpful in targeting stereotactic biopsy.

Decisions about prophylactic gynecologic surgery: a qualitative study of the experience of female Lynch syndrome mutation carriers.

BackgroundWomen who carry a mutation for Lynch syndrome face complex decisions regarding strategies for managing their increased cancer risks. At present, there is limited understanding of the factors influencing women’s prophylactic surgery decisions.MethodsAs part of an exploratory pilot project, semi-structured interviews were conducted with 10 women who were Lynch syndrome mutation carriers and had made prophylactic surgery decisions. Nine of 10 women had chosen to undergo prophylactic hysterectomy and/or oophorectomy as a means of managing their increased gynecological cancer risks.ResultsStudy findings revealed that surgery decisions were influenced by multiple factors, including demographic variables such as age and parity, as well as psychosocial factors such as cancer worry, in addition to personal and social knowledge of gynecological cancer. While all women were satisfied with their surgery decision, some reported they were not fully informed about the negative impact on their quality of life post-surgery (e.g., complications of surgically-induced menopause), nor about the potential for, or risks and benefits of, hormone replacement therapy.ConclusionsStudy findings highlight some of the factors associated with prophylactic surgery decisions and women’s perceptions about pre-surgical information provision and needs. Suggestions are made for improving the information and support provided to female carriers of a Lynch syndrome mutation.

Clinical Role of Subtraction Ictal SPECT Coregistered to MR Imaging and18F-FDG PET in Pediatric Epilepsy

A precise assessment of the drug-resistant epileptic pediatric population for surgical candidacy is often challenging, and to date there are no evidence-based guidelines for presurgical identification of the epileptogenic zone. To evaluate the usefulness of radionuclide imaging techniques for presurgical evaluation of epileptic pediatric patients, we compared the results of video-electroencephalography (EEG), brain MR imaging, interictal SPECT, ictal SPECT, subtraction ictal SPECT coregistered to MR imaging (SISCOM), and interictal PET with (18)F-FDG. Fifty-four children with drug-resistant epilepsy who had undergone video-EEG monitoring, brain MR imaging, interictal and ictal brain perfusion SPECT, SISCOM, and (18)F-FDG PET were included in this study. All abnormal findings revealed by these neuroimaging techniques were compared with the presumed location of the epileptogenic zone (PEZ) as determined by video-EEG and clinical data. The proportion of localizing studies for each technique was statistically compared. In the 18 patients who underwent resective brain surgery, neuroimaging results were compared with histopathology results and surgical outcome. SISCOM and (18)F-FDG PET concordance with the PEZ was significantly higher than MR imaging (P < 0.05). MR imaging showed localizing results in 21 of 54 cases (39%), SISCOM in 36 of 54 cases (67%), and (18)F-FDG PET in 31 of 54 cases (57%). If we consider SISCOM and (18)F-FDG PET results together, nuclear medicine imaging techniques showed coinciding video-EEG results in 76% of patients (41/54). In those cases in which MR imaging failed to identify any epileptogenic lesion (61% [33/54]), SISCOM or (18)F-FDG PET findings matched PEZ in 67% (22/33) of cases. SISCOM and (18)F-FDG PET provide complementary presurgical information that matched video-EEG results and clinical data in three fourths of our sample. SISCOM was particularly useful in those cases in which MR imaging findings were abnormal but no epileptogenic lesion was identified. Radionuclide imaging techniques are both useful and reliable, extending the possibility of surgical treatment to patients who may have been discouraged without a nuclear medicine approach.

Evaluation Objective Des Symptomes : Et Information Des Patientes

Genital prolapse is a functional pathology presenting with numerous urinary, genito-sexual, and anorectal symptoms. These symptoms are responsible for an alteration of the quality of life, sometimes associated to a real anxiety-depressive syndrome. Because of these complex intricacies, the management of these disorders became multidisciplinary. Tools to measure the impact of prolapse symptoms on the quality of life became a necessity. Such instruments should allow a correlation of the functional symptomatology at the anatomic stage, raise a surgical indication based on the functional disturbance and evaluate the effectiveness and tolerance of the various therapeutic procedures. Two validated self-questionnaires in French (short versions of the Pelvic Floor Distress Inventory [PFDI-20] and the Pelvic Floor Impact Questionnaire [PFIQ-7]) are presently available. Moreover, the physician has the legal obligation to provide detailed presurgical information on frequent and severe hazards, expected benefits, functional consequences, therapeutic alternatives and the consequences of nonintervention. Before surgery takes place, the surgical approach, the benefit of using synthetic prostheses, the possibility of uterine and/or ovarian conservation, and some risky conditions such as smoking, obesity and estrogen deficiency should be discussed.

A systematic review of functional magnetic resonance imaging and diffusion tensor imaging modalities used in presurgical planning of brain tumour resection

Historically, brain tumour resection has relied upon standardised anatomical atlases and classical mapping techniques for successful resection. While these have provided adequate results in the past, the emergence of new technologies has heralded a wave of less invasive, patient-specific techniques for the mapping of brain function. Functional magnetic resonance imaging (fMRI) and, more recently, diffusion tensor imaging (DTI) are two such techniques. While fMRI is able to highlight localisation of function within the cortex, DTI represents the only technique able to elucidate white matter structures in vivo. Used in conjunction, both of these techniques provide important presurgical information for thorough preoperative planning, as well as intraoperatively via integration into frameless stereotactic neuronavigational systems. Together, these techniques show great promise for improved neurosurgical outcomes. While further research is required for more widespread clinical validity and acceptance, results from the literature provide a clear road map for future research and development to cement these techniques into the clinical setup of neurosurgical departments globally.

Clinical Standardized fMRI Reveals Altered Language Lateralization in Patients with Brain Tumor

Brain tumors affecting language-relevant areas may influence language lateralization. The purpose of this study was to systematically investigate language lateralization in brain tumor patients using clinical language fMRI, comparing the results with a group of healthy volunteers. Fifty-seven strictly right-handed patients with left-hemispheric-space intracranial masses (mainly neoplastic) affecting either the Broca area (n = 19) or Wernicke area (n = 38) were prospectively enrolled in this study. Fourteen healthy volunteers served as a control group. Standardized clinical language fMRI, using visually triggered sentence- and word-generation paradigms, was performed on a 1.5T MR scanner. Semiautomated analyses of all functional data were conducted on an individual basis using BrainVoyager. A regional lateralization index was calculated for Broca and Wernicke areas separately versus their corresponding right-hemisphere homologs. In masses affecting the Broca area, a significant decrease in the lateralization index was found when performing word generation (P = .0017), whereas when applying sentence generation, the decrease did not reach statistical significance (P = .851). Masses affecting the Wernicke area induced a significant decrease of the lateralization index when performing sentence generation (P = .0007), whereas when applying word generation, the decrease was not statistically significant (P = .310). Clinical language fMRI was feasible for patients with brain tumors and provided relevant presurgical information by localizing essential language areas and determining language dominance. A significant effect of the brain masses on language lateralization was observed, with a shift toward the contralesional, nondominant hemisphere. This may reflect compensatory mechanisms of the brain to maintain communicative abilities.

Reflex Immunohistochemistry and Microsatellite Instability Testing of Colorectal Tumors for Lynch Syndrome Among US Cancer Programs and Follow-Up of Abnormal Results

Immunohistochemistry (IHC) for MLH1, MSH2, MSH6, and PMS2 protein expression and microsatellite instability (MSI) are well-established tools to screen for Lynch syndrome (LS). Although many cancer centers have adopted these tools as reflex LS screening after a colorectal cancer diagnosis, the standard of care has not been established, and no formal studies have described this practice in the United States. The purpose of this study was to describe prevalent practices regarding IHC/MSI reflex testing for LS in the United States and the subsequent follow-up of abnormal results. A 12-item survey was developed after interdisciplinary expert input. A letter of invitation, survey, and online-survey option were sent to a contact at each cancer program. A modified Dillman strategy was used to maximize the response rate. The sample included 39 National Cancer Institute-designated Comprehensive Cancer Centers (NCI-CCCs), 50 randomly selected American College of Surgeons-accredited Community Hospital Comprehensive Cancer Programs (COMPs), and 50 Community Hospital Cancer Programs (CHCPs). The overall response rate was 50%. Seventy-one percent of NCI-CCCs, 36% of COMPs, and 15% of CHCPs were conducting reflex IHC/MSI for LS; 48% of the programs used IHC, 14% of the programs used MSI, and 38% of the programs used both IHC and MSI. One program used a presurgical information packet, four programs offered an opt-out option, and none of the programs required written consent. Although most NCI-CCCs use reflex IHC/MSI to screen for LS, this practice is not well-adopted by community hospitals. These findings may indicate an emerging standard of care and diffusion from NCI-CCC to community cancer programs. Our findings also described an important trend away from requiring written patient consent for screening.

New method for 3D reconstruction of the human cranial vault from CT-scan data

This study presents a new method for the 3D reconstruction of the human cranial vault from routine Computed Tomography (CT) data. The reconstruction method was based on the conceptualization of the shape of the cranial vault with a parametric description. An initialization was first realized with the identification of anatomical landmarks and contours on Digitally Reconstructed Radiographs (DRR) in order to obtain a pre-personalized reconstruction. Then an optimization of the reconstruction was performed to segment the internal and external surfaces of the cranial vault for thickness computation. The method was validated by comparing final reconstructions issued from our approach and from a manual slice-by-slice segmentation method on ten CT-scans. Errors were comparable to the CT image resolution, and less than 2 min were dedicated to the operatordependant marking step. The reconstruction of internal and external surfaces of the cranial vault allows quantifying and visualizing of thickness throughout the cranial vault. This thickness mapping is useful for clinical purposes as additional pre-surgical information. Moreover, this study constitutes a first step in the personalized characterization of skull resistance directly from routine exams.

Beratung zur erektilen Dysfunktion während stationärer Rehabilitation nach radikaler Prostatektomie

For men erectile function is essential for quality of life. Besides urine incontinence postsurgical erectile dysfunction (ED) following radical prostatectomy (RPE) represents a significant and prevalent problem. One of the first approaches to this condition should be a consultation performed by professionals in a rehabilitation clinic.A total of 149 patients post RPE participated in this prospective study. All patients were questioned about their understanding of postoperative surgical ED after RPE and if affected they were asked about their own psychological burden as well as their knowledge of possible therapy options. The qualities of presurgical patient information as well as the modules of information pertaining to ED during the rehabilitation were evaluated. Of the patients, 53% expressed that they experienced a considerable burden due to postsurgical ED during their follow-up rehabilitation (AR group) and 70% of the patients during oncological rehabilitation treatment (rehab group). Men who were sexually more active prior to surgery suffered more from postsurgical ED than their less active counterparts. A negative correlation between psychological burden and age was found in the AR group, which however was levelled in the rehab group. Particularly in older patients the burden of ED increases with more time elapsing after the operation. The medical information on ED therapy options provided during the inpatient rehabilitation was considered to be essential by 60% of the men in the AR group and 48% of the patients in the rehab group.Therapeutic possibilities for postsurgical ED following RPE cannot always be given to patients in the preoperative phase or during their stay in the hospital. Since however a large majority of men suffer from postoperative ED following RPE a specialized inpatient urological rehabilitation is suited for a comprehensive consultation.

Brain surface motion imaging to predict adhesions between meningiomas and the brain surface

"Brain surface motion imaging" (BSMI) is the subtraction of pulse-gated, 3D, heavily T2-weighted image of two different phases of cerebrospinal fluid (CSF) pulsation, which enables the assessment of the dynamics of brain surface pulsatile motion. The purpose of this study was to evaluate the feasibility of this imaging method for providing presurgical information about adhesions between meningiomas and the brain surface. Eighteen cases with surgically resected meningioma in whom BSMI was presurgically obtained were studied. BSMI consisted of two sets of pulse-gated, 3D, heavily T2-weighted, fast spin echo scans. Images of the systolic phase and the diastolic phase were obtained, and subtraction was performed with 3D motion correction. We analyzed the presence of band-like texture surrounding the tumor and judged the degree of motion discrepancy as "total," "partial," or "none." The correlation between BSMI and surgical findings was evaluated. For cases with partial adhesions, agreements in the locations of the adhesions were also evaluated. On presurgical BSMI, no motion discrepancy was seen in eight cases, partial in six cases, and total in four cases. These presurgical predictions about adhesions and surgical findings agreed in 13 cases (72.2%). The locations of adhesions agreed in five of six cases with partial adhesions. In the current study, BSMI could predict brain and meningioma adhesions correctly in 72.2% of cases, and adhesion location could also be predicted. This imaging method appears to provide presurgical information about brain/meningioma adhesions.

Resting-state Spontaneous Fluctuations in Brain Activity: A New Paradigm for Presurgical Planning Using fMRI

Task-evoked functional MRI (fMRI) has been used successfully in the study of brain function and clinically for presurgical localization of eloquent brain regions prior to the performance of brain surgery. This method requires patient cooperation and is not useful in young children or if the patient has cognitive dysfunction or physical impairment. An alternative method that can overcome some of these disadvantages measures the intrinsic function of the brain using resting-state fMRI. This method does not require any task performance and measures the spontaneous low-frequency (<0.1 Hz) fluctuations of the fMRI signal over time. Our objective in the present work is to provide preliminary information on the possible clinical utility of this technique for presurgical planning and on possible future applications. Data from prior fMRI resting-state studies were reviewed for their potential use in preoperative mapping. Structural and resting-state fMRI data from normal subjects and patients with brain tumors were preprocessed and seed regions were placed in key regions of the brain; the related functional networks were identified using correlation analysis. Several key functional networks can be identified in patients with brain tumors from resting-state fMRI data. Resting-state fMRI data can provide valuable presurgical information in many patients who cannot benefit from traditional task-based fMRI. Adoption of this method has the potential to improve individualized patient-centered care.

Patient self‐evaluation of intra‐oral bone grafting treatment to the maxillary frontal region

Bone grafting to the anterior region of the maxilla is a treatment method often used for reconstruction after dental trauma when teeth have been lost. The purpose of this study was to interview patients who underwent bone grafting from the chin or lateral mandible to assess the patients' experiences, especially regarding morbidity of the donor site and their overall assessment of treatment and care. Twenty-six patients who had undergone bone grafting from the chin and lateral mandible regions before implant treatment were interviewed about their experiences of treatment and present status 3-5 years after surgery. The patients rated the quality of presurgical information, quality of care, postoperative discomfort, postoperative pain, present discomfort and satisfaction with the final results. The patients, in general, were positive to the presurgical information and the quality of care. Postoperative pain during the first week was rated higher when grafts were taken from the chin than from the lateral mandible. Patient satisfaction with the outcome was high 3-5 years after surgery. However, patients that underwent bone grafting from the lateral mandible rated discomfort significantly lower and satisfaction significantly higher than patients who underwent chin grafting. More discomfort was reported in patients where wide bone grafts had been taken from the chin. A high degree of patient satisfaction with treatment and outcome can be expected after intra-oral bone grafting. However, surgeons should be cognizant of and patients informed about the risks of morbidity, especially when harvesting wide bone grafts from the chin. If possible, a first-hand choice for the surgeon should be grafting from the lateral mandible before considering chin graft.

Estudio Observacional PATHOS sobre el dolor postoperatorio leve o moderado. Comparación de los resultados de España frente a Europa

The Postoperative Analgesic Therapy Observational Survey (PATHOS) was designed to identify the current state of postoperative pain in specific areas and the needs and opportunities for improving treatment. We compared the results obtained in Spain with those obtained in the rest of Europe between August 2004 and June 2005. A prospective observational multicenter, multinational study in 7 European countries. The data on postoperative pain management were obtained anonymously by means of a standardized multiple-choice questionnaire. Participation was higher among surgeons (68%) in Spain and among anesthesiologists (69%) in other European countries. Systematic presurgical information on the treatment of postoperative pain was provided to 22.2% of patients undergoing surgery in Spain. Organized structures for the treatment of postoperative pain are less common in Spanish hospitals (47%) than in other European hospitals (69%). Anesthesiologists are less often those who inform patients about postoperative pain in Spain than in other European countries. Only 25.9% of Spanish hospitals have written protocols for treating postoperative pain. Pain was not evaluated in 39% of patients who underwent surgery in Spain. There is inadequate treatment of postoperative pain, and the problem is greater in Spain than in the other European countries participating in PATHOS. The results should help to identify opportunities for improvement.

Informed consent and decision making by cataract patients.

To investigate decision making by patients on the day before cataract surgery and to evaluate to what extent the informed consent process influences the patients' decision regarding consent. On the day before surgery, 70 patients (mean +/- SD age, 70.3 +/- 10.3 years) underwent a standardized informed consent procedure. They were also invited to answer 15 questions established in interdisciplinary cooperation among clinical psychologists, lawyers, and ophthalmologists. We assessed presurgical information and personal estimation of risks in cataract surgery; the patient-physician relationship regarding surgery-related decisions; and evaluations of the informed consent procedure and the patients' decision. Questionnaire answers indicated that 28 (40%) of the 70 participating patients arrived for surgery without any information; 16 (23%) believed that there were surgical procedures without risks; and 53 (76%) estimated that there were no risks for their cataract surgery. A physician-dominated decision for surgery was preferred by 31 patients (44%); 16 (26%) wanted to decide together with their ophthalmologist. Possible risks of a sight-threatening complication did not influence 54 patients' (77%) decisions, and 55 patients (78%) said the informed consent process did not influence their decision. The remaining 15 (22%) stated that the informed consent process positively confirmed their decision. Informed consent 1 day preoperatively does not seem to influence the decision for cataract surgery. Cognitive dissonance as part of a decision-making process makes changes in an already chosen option unlikely. The resulting limited decisive potential is very important for credibility in a trial and has to be considered in ophthalmologic surgery.

Patients' need for information before surgery

Frequently, prior to surgery, patients are provided with information in order to meet legal and hospital requirements, but without taking their psychological needs into consideration. In order to learn how to improve this situation, the present study was performed. By means of a semi-structured interview including a newly constructed card system, that avoids giving patients undemanded and possibly harmful implicit information, the need for information of 60 patients before hip- or knee-replacement surgery were investigated in great detail. The results show that 83.3% of the patients want to be prepared by the surgeon, preferably by means of an oral communication (75.0%). Most frequently the day when decision for surgery is made and the day of hospitalization were preferred as point of time for preparation (30% each). Patients were more interested in information about the operation and recovery (43.3% each) than about risks (33.3%). Only 11.7% wanted to get psychological preparation prior to surgery. We conclude that coming into contact and establishing a trustful relationship with the surgeon who does the operation is the most crucial need of surgical patients. He should give presurgical information according to the patient's needs, which often do not focus on the risks, as legal regulations do. By providing psychological preparation for the small number of patients in need, psychological specialists may contribute to improve satisfaction and outcome of surgical patients.