Patient noncompliance before surgery

Study Type – Therapy (case series)
Level of Evidence 4

OBJECTIVE

To assess patient compliance with preoperative instructions and to determine causes and factors of noncompliance, as noncompliance might affect surgical outcome and has potential medicolegal implications.

PATIENTS AND METHODS

One surgeon counselled 101 consecutive patients before undergoing laparoscopic renal surgery. Deliberate discussions instructed patients to bring their radiograph films on the day of surgery and complete a preoperative bowel preparation. Noncompliance was defined as failure to bring films and/or complete bowel preparation. Patient demographics, socio‐economic and clinical variables were analysed, and reasons for failure to comply with instructions were also recorded.

RESULTS

Twenty‐four of the 101 (24%) patients were not compliant, 13 with films only, seven with bowel preparation only, and four with both sets of instructions. Univariate analysis showed that language and race were factors for noncompliance. Multivariate analysis showed that non‐Caucasians had 17 times the risk of noncompliance (P < 0.001); long distance from home to the site of care had five times the risk of noncompliance (P = 0.041), and each day between the initial consultation and the date of surgery had 1.05 times the risk of noncompliance (P < 0.001). The most common reason given by patients for noncompliance was that they were never given the preoperative instructions.

CONCLUSIONS

Noncompliance with preoperative surgical instructions is a significant issue and is increased in non‐Caucasian patients, those travelling long distances, and those whose surgery date is long after their preoperative consultation. A systems‐based approach is needed to address this significant issue.