Surgical consent, perception of the patients who underwent a surgical operation in the Kurdistan region, Iraq | BMC Medical Ethics

The patient is central to surgical management, which is an invasive procedure with potential complications, including mortality. Therefore, the patient should be informed about every aspect of the procedure, from the identity of the operating surgeon to all details of the perioperative period. Most participants asserted that they thoroughly understood this information; compared to the study done, only 38% of their participants were satisfied with the information given during consent [7].

Around 60% of patients in our study confirm that the operating surgeons review the procedure details and obtain their consent. This aligns with the views of participants from Egypt, where about 89% of physicians and 75% of patients believe that acquiring a signed consent form is the responsibility of the physicians’ task [5]; conversely, 27.8% of the consent was obtained by nurses, According to a study that was carried out in Kirkuk, which is one of the cities that are located close to the region, more than three-quarters of surgical consents were collected by nurses [8]. In contrast, research conducted in a tertiary hospital in Pakistan indicated that all consents were secured by physicians, surgeons, or surgical trainers [6]. Although no explicit regulations exist in our region about who is accountable for obtaining consent, it is generally understood that the surgeon doing the operation is the most appropriate to discuss the procedure, as noted in international reviews [9]0.58.6% of respondents indicated that surgeons provide explanations of the surgery before obtaining consent. Approximately 16% reported that junior doctors, rather than surgeons, deliver this information. Furthermore, a study found no statistically significant difference between the explanations provided by surgeons and those given by junior doctors [10].

While a lack of statistical significance was observed in academic education levels concerning the explanation of the consent form, consistent with a study conducted in Muscat in 2024, 35% of participants in our study reported inadequate explanation of the form, compared to 22% of participants in the Muscat study who expressed similar concerns [11], Most research participants in Pakistan assert that inadequate time was allocated for consent, with no statistically significant difference between illiterate and literate individuals. Conversely, our study revealed a significant statistical difference in educational levels (P value < 0.001), with most participants indicating insufficient time was permitted [6].

Approximately 60% of our participants said that surgeons obtained consent, while 27.8% reported nurses obtained it. In a survey conducted among physicians in Croatia, 60% of surgeons believed that it is the physician’s responsibility to get consent, whereas 24% thought it is the nurse’s responsibility [12].

Anesthesia is a crucial component of surgical procedures, and the anesthetist is vital to the surgical team; however, it is noteworthy that three-quarters of our participants are unaware of an anesthetist’s involvement with operations, with the significant statistical difference in educational level (P value < 0.001) a considerable number of the participants deny taking information about the type of anesthesia and complication of anesthesia (20% and 38%) respectively, comparing to other studies 26% and 83% of participants satisfy about anesthesia details [6, 7].

In our region, the coexistence of public and private hospitals necessitates a comparison of consent-taking practices across these sectors. The cost of surgery is particularly critical in the private sector. Our analysis revealed a statistically significant difference in patients’ awareness of surgical costs, with 37% of respondents unaware of the price. Additionally, there was a similar statistically significant difference regarding the information provided about the surgeon and anesthetist and the opportunity to discuss the procedure. These findings align closely with surveys conducted in other countries comparing both sectors [13, 14].

Before surgery, patients should be informed about the procedure’s expectations, including potential postoperative complications and recovery time. More than half of those surveyed believe this information is discussed during the informed consent process, which is a higher percentage compared to a study conducted in Turkey in 2015 on the same topic [15]. The local Kurdistan regional government publishes and distributes a booklet outlining all anticipated common complications across all surgical wards, which is believed to enhance patient satisfaction regarding their information.

Currently, no health insurance is available in our locality, and public hospitals operate under a semiprivate system requiring patients to pay out-of-pocket in addition to their free services. Therefore, patients need to be informed about the surgery cost before the operation, as research indicates that patients in the USA prefer to discuss costs before treatment decisions are made [16]; approximately 38% of participants report not obtaining pricing information, with nearly half of public hospital patients exhibiting the same trend. This finding warrants serious consideration, and decision-makers should guide this matter.

The comparison between the public and private sectors, coupled with the educational attainment of many participants, represents a notable strength of our study concerning others in this field. A significant number of participants in direct interviews identified another key strength: the authenticity of the situation presented.

The lack of participation from the responsible surgeons is considered a limitation, and comparing outcomes and deficiencies with their involvement would have been more advantageous. The electronic aspects of consent in the context of artificial intelligence require greater emphasis in future research endeavors. Comparing various surgical specialties and distinguishing between emergency and elective procedures requires greater attention to detail.