Qualitative study of clinician and patient perspectives on the mode of anaesthesia for emergency surgery

Background:
While delivering an alternative mode of anaesthesia for certain emergency surgery procedures is potentially beneficial to patients, it is a complex intervention to evaluate. This qualitative study explored clinician and patient perspectives about mode of anaesthesia for emergency surgery.

Method:
Semi-structured interviews were conducted between December 2017 and July 2018. Snowball sampling was used to recruit participants from 8 NHS trusts across three emergency surgery clinical contexts: ruptured AAAs, hip fractures, and inguinal hernias. Thematic analysis was applied to the interview transcripts.

Results:
Seventy-nine interviews were conducted with 21 anaesthetists, 21 surgeons, 14 other theatre staff and 23 patients. There were two main themes. The first, Impact of mode of anaesthesia in emergency surgery, has 4 subthemes related to clinician and patient ideas about: context and the “best” mode of anaesthesia, the balance in choosing a mode of anaesthesia, change and developments in anaesthesia, and the importance of anaesthesia mode in emergency surgery. The second, Tensions in decision making about anaesthesia mode, comprises 4 subthemes: clinical autonomy and anaesthesia guidelines, conforming to norms in mode of anaesthesia, the relationship between expertise, preference, and patient involvement, and team dynamics in emergency surgery.

Conclusion:
Decisions about mode of anaesthesia in emergency surgery depend upon several interlinking factors, including expertise, preference, habit, practicalities, norms and policies. There is variation in practice in choosing modes of anaesthesia, alongside debate as to whether anaesthetic autonomy is necessary or results in a lack of willingness to change.