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This website is under development - The information contained on this site is for guidance only and is not intended for self diagnosis or self treatment. This will not replace professional medical advice or consultation. Always seek the professional advice of a qualified health care professional.   
Pre Op Check list - patient    Consent form

Extract from a typical consent form - This is what you typically agree to when you sign the consent form:

A) You will agree to the procedure or treatment described and confirm that you have understood the discussion today even though you may not remember everything discussed in the future.

B) You will accept that no guarantee can be given that a particular person will perform the procedure. However, I will be the lead surgeon or first assistant for all the operations for which I seek your consent.

C) You will acknowledge that you had opportunity to discuss the type of anaesthesia with the anaesthetist.

D) You will acknowledge that any additional procedure will only be carried out if it is necessary to save my life or to prevent serious harm to my health or if it will significantly improves the outcome. Occasionally, tissue samples will be taken for analysis to improve or to plan any additional treatment.

E) If you are a Jehovah witness or have a living will / advance directive which I wish to be adhered to. Then it is your duty to inform the doctor and the person appointed to take healthcare decisions on your behalf should you become incapacitated under a Lasting Power of Attorney.  


Chances of Occuring


1:100 (Can be treated on most occasions)


1:50 (Can be controlled and stopped)


1:20 (will improve with physiotherapy)

Damage to skin nerves

Very common, nuisance side effect

Damage to deep nerves or blood vessel

1:100 (will recover or can be treated)

Complex Regional Pain Syndrome

1:50 (minor and subclinical) to 1:500 (severe)

Aggravation of pain (side effect)

1:5 for cuff repair (will settled with time and medications)

1:20 for other procedures

Recurrence of problems

1:50 to 1:300 depending upon procedure and conditions

Re-tear risks in rotator cuff repair

Depends upon size of tear - Every 1 cm carried 10% failure rate

1:20 (Tear < 1 cm)

1:10 (Tear 1-2 cm)

1:5 (Tear 2-3 cm)

1:4 (Tear 3-4 cm)

1:3 (tear 4-5 cm)

!;2 (tear > 5 cm)

Slow recovery (side effect)

1:20 to 1:50 (depending on procedure)

Blood clot formation - DVT/PE

1:300 to 1:500 (needing treatment)

Retention of urine (men more common)

1:100 (with prostrate problem) to 1:300

Heart related problems (like heart attack, arrhythmia etc)

1:1000 (can be treated)

Lung related complication - (like pneumonia etc

1:1000 (can be treated)

Death - Depending of underlying co-morbidities

1:2000 or less

The following details some of the commonly stated risks & complications - Please note that this list is not complete. Each person’s risk profile will be different and additional risks will be discussed. This based on my personal experience and reference to some published literature.