• Barbara L Conner-Spady, Deborah A Marshall, Eric Bohm, Michael J Dunbar, Lynda Loucks, Allan W Hennigar, Cy Frank, and Tom W Noseworthy.
• *Department of Community Health Sciences, University of Calgary, Calgary, AB †Concordia Joint Replacement Group, University of Manitoba, Winnipeg, MB ‡Department of Orthopaedic Surgery, Dalhousie University, Halifax, NS §Concordia Hip and Knee Institute, Winnipeg, MB ∥Division of Orthopaedic Surgery, Dalhousie University, QEII Health Sciences Centre, Halifax, NS ¶Faculty of Medicine, University of Calgary, Calgary, AB, Canada.
• Med Care. 2014 Apr 1;52(4):300-6.

BackgroundAlthough the option of next available surgeon can be found on surgeon referral forms for total joint replacement surgery, its selection varies across surgical practices.ObjectivesObjectives are to assess the determinants of (a) a patient's request for a particular surgeon; and (b) the actual referral to a specific versus the next available surgeon.MethodsQuestionnaires were mailed to 306 consecutive patients referred to orthopedic surgeons. We assessed quality of life (Oxford Hip and Knee scores, Short Form-12, EuroQol 5D, Pain Visual Analogue Scale), referral experience, and the importance of surgeon choice, surgeon reputation, and wait time. We used logistic regression to build models for the 2 objectives.ResultsWe obtained 176 respondents (response rate, 58%), 60% female, 65% knee patients, mean age of 65 years, with no significant differences between responders versus nonresponders. Forty-three percent requested a particular surgeon. Seventy-one percent were referred to a specific surgeon. Patients who rated surgeon choice as very/extremely important [adjusted odds ratio (OR), 6.54; 95% confidence interval (CI), 2.57-16.64] and with household incomes of $90,000+ versus <$30,000 (OR, 5.74; 95% CI, 1.56-21.03) were more likely to request a particular surgeon. Hip patients (OR, 3.03; 95% CI, 1.18-7.78), better Physical Component Summary-12 (OR, 1.29; 95% CI, 1.02-1.63), and patients who rated surgeon choice as very/extremely important (OR, 3.88; 95% CI, 1.56-9.70) were more likely to be referred to a specific surgeon.ConclusionsMost patients want some choice in the referral decision. Providing sufficient information is important, so that patients are aware of their choices and can make an informed choice. Some patients prefer a particular surgeon despite longer wait times.

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