Ethical Considerations in Informed Consent: Contrasting Inpatient and Outpatient Laryngectomy

Introduction: Laryngectomy preoperative counseling is an extensive process, involving speech language pathology, family meetings, and occupational health to aid in shared decision making. Patients presenting to the ED and admitted due to airway concerns secondary to laryngeal cancer often have an inpatient laryngectomy, which may limit the time and resources available for comprehensive counseling. We aim to compare the consent process between inpatient and outpatient laryngectomy, identifying the ethical implications of limitations in the inpatient setting.

Methods: We retrospectively reviewed 10 years of data for laryngectomy patients at our institution, a level 1 trauma center in Southern California. Patients were categorized based on the setting where they were counseled. The outpatient laryngectomy group consisted of patients who had the time and opportunity to undergo outpatient preoperative multidisciplinary counseling. The inpatient laryngectomy group consisted of patients who, for a multitude of reasons, presented to the ED in respiratory distress due to mass effect. These patients were admitted and made the decision to undergo laryngectomy in the inpatient setting. We compare the resources made available to these groups.

Results: A total of 52 inpatients and 182 outpatients were analyzed. We have compiled a table of the resources available to laryngectomy patients in the inpatient vs outpatient setting. The inpatient group received less multidisciplinary counseling and relied on surrogate decision makers more often than the outpatient group.

Conclusions: Patients undergoing inpatient laryngectomy have a truncated consent process and preoperative counseling when compared to their peers in the outpatient setting. These findings draw into consideration the ethical propriety of inpatient laryngectomy. In some cases, it may be prudent to stabilize patients with tracheostomy and pursue laryngectomy after subsequent counseling to ensure shared decision making and adequate resource availability in the consent process.