Interval Post Operative Retention of Key Portions of the Informed Consent Discussion in the Adult Deformity Patient IRB Approval Date:

Interval Post Operative Retention of Key Portions of the Informed ConsentDiscussion in the Adult Deformity Patient IRB Approval Date:

For spinal deformity patients who have agreed to participate in the

informed consent study

This video is for research purposes only. It does not take the place of a consent form. The complications listed are the more

common complications but this is not included every complications you might experience.

Please talk to your physician if you have any questions.

Please talk to your physician if you have questions about this video or the risks discussed or any additional questions about this procedure.

How important do you think the informed consent process is on a scale of 1-10 with 10 being most important?

1 2 3 4 5 6 7 8 9 10

Infection (2-5%) Inadequate pain relieve or new pain (5-20%) Need for more surgery (15-25%) Medical complications (10-20%) Weakness (5-10%) Skin or muscle or nerve positioning complication (2-5%) Instrumentation malposition (.5-20%) CSF leak (2-10%) Bleeding that requires transfusion (50-75%) Death (.5-2%) Blindness ( less than 1%)

Rate 2-5%

(5-20%)

(15-25%)

(10-20%)

(Approx 5-10%)

(2-5%)

(.5-20%)

(2-10%)

(50-75%)

( less than 1%)

(.5-2%)

Infection (2-5%) Inadequate pain relieve or new pain (5-20%) Need for more surgery (15-25%) Medical complications (10-20%) Weakness (5-10%) Skin or muscle or nerve positioning complication (2-5%) Instrumentation malposition (.5-20%) CSF leak (2-10%) Bleeding that requires transfusion (50-75%) Death (.5-2%) Blindness ( less than 1%)

How well informed do you feel now after the consent process on a scale of 1-10 with 10 being very well informed and 1 being not well informed at all?

1 2 3 4 5 6 7 8 9 10

How important do you think the informed consent process is on a scale of 1-10 with 10 being most important?

1 2 3 4 5 6 7 8 9 10

How much did the slide show help on a scale of 1-10 with 10 being most helpful and 1 not helpful at all?

1 2 3 4 5 6 7 8 9 10

What do you think is your risk of experiencing one of these complications?

0% 10% 20% 30% 40% 50%

60% 70% 80% 90% 100%

11 possible risks of my surgery are: _____________________ _____________________ _____________________ _____________________ _____________________ _____________________ _____________________ _____________________ _____________________ _____________________ _____________________

Recall common or uncommon Is this a major or minor complication

Common Rare

1 Minor 2 3 4 5 6 7 8 9 10 Very severe

Common Rare

1 Minor 2 3 4 5 6 7 8 9 10 Very severe

Common Rare

1 Minor 2 3 4 5 6 7 8 9 10 Very severe

Common Rare

1 Minor 2 3 4 5 6 7 8 9 10 Very severe

Common Rare

1 Minor 2 3 4 5 6 7 8 9 10 Very severe

Common Rare

1 Minor 2 3 4 5 6 7 8 9 10 Very severe

Common Rare

1 Minor 2 3 4 5 6 7 8 9 10 Very severe

Common Rare

1 Minor 2 3 4 5 6 7 8 9 10 Very severe

Common Rare

1 Minor 2 3 4 5 6 7 8 9 10 Very severe

Common Rare

1 Minor 2 3 4 5 6 7 8 9 10 Very severe

Common Rare

1 Minor 2 3 4 5 6 7 8 9 10 Very severe

Infection (2-5%) Inadequate pain relieve or new pain (5-20%) Need for more surgery (15-25%) Medical complications (10-20%) Weakness (5-10%) Skin or muscle or nerve positioning complication (2-5%) Instrumentation malposition (.5-20%) CSF leak (2-10%) Bleeding that requires transfusion (50-75%) Death (.5-2%) Blindness ( less than 1%)

This video is for research purposes only. It does not take the place of a consent form. The complications listed are the more

common complications but this is not included every complications you might experience.

Please talk to your physician if you have any questions.

Please talk to your physician if you have questions about this video or the risks discussed or any additional questions about this procedure.