Purpose: While past epidemiologic research has identified hazards of individual surgical procedures, little is known as to what cultural notions individuals share regarding potential downsides of surgery. We aimed to characterize themes common to older adults’ perceptions of surgery's hazards and assess racial and gender variations in these themes.
Methods: We interviewed English-speaking white and black adults aged 70 and older in an urban outpatient geriatric medicine practice. We conducted a freelist exercise, asking participants to list as many “downsides of surgery” as possible, and collected data on demographics and medical history. We ranked items by Smith’s S, a measure of saliency incorporating information on item frequency and rank. We used scree plots to identify highly salient items, and conducted content analysis of salient items by race and gender. We tested for a single, “culturally correct” understanding of the downsides of surgery via cultural consensus analysis among the full sample and by race and gender.
Results: Out of 60 participants, 53% were black, and 47% were white. 30% were male; gender distributions did not differ by race. Our median patient was 76 years old (IQR 69, 82), reported 2 prior surgical procedures (IQR 1, 4), and verified 4 of 14 Charlson comorbidities (IQR 3, 5). 12% reported not completing high school, and 25% lived with a spouse or domestic partner. Both black and white participants viewed pain and the time required for recovery as the two most salient downsides of surgery; whereas the need for anesthesia and perceptions of being “too old” for surgery were more salient among blacks, the risk of death was more salient among whites. Both males and females viewed pain as the most salient downside to surgery; however, the inability to care for one’s self after surgery was salient only among females. Cultural consensus analysis indicated no single “culturally correct” definition of surgery’s downsides in the full sample or by race or gender.
Conclusions: Participants of differing race and gender voiced many of the same concerns regarding surgical care, yet notable subgroup differences in salient terms also occurred. Differing responses between males and females may reflect variations in available social supports. Further research is needed to understand the implications of group differences in perceptions of surgery’s hazards for medical decision-making.
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