Abstract
BACKGROUND: Surgeons must discuss the most severe surgical complications with their patients while making a treatment decision. However, it is unclear which complications patients deem most severe. This study aimed to have patients classify potential complications following abdominal aortic aneurysm surgery based on severity using best-worst scaling. METHODS: Dutch patients with an abdominal aortic aneurysm, either under surveillance or following surgery, received a survey with 33 potential surgical complications. The survey presented these complications in sets of three. Patients had to classify one of three complications as most severe and one as least severe. After all participants had completed the survey, the number of times a complication was classified as most severe was subtracted from the number of times that the complication was classified as least severe, thus resulting in a best-worse scaling score. Complications with the lowest scores were ranked as more severe. RESULTS: Fifty out of 79 participating patients completed the survey in full. Patients classified the following ten complications as most severe: Below-ankle amputation, aneurysm rupture, stroke, renal failure, type 1 endoleak, spinal cord ischaemia, peripheral bypass surgery, bowel lesion, myocardial infarction and heart failure. Haematoma was ranked as the least severe complication. CONCLUSION: This best-worst scaling study enabled patients to classify complications following abdominal aortic aneurysm surgery based on severity. Vascular surgeons should discuss the ten complications deemed most severe with their patients and help their patients to effectively weigh the benefits of surgery against the harms patients themselves deem important, thereby improving shared decision making.