Surgeon Perception of Risk and Benefit in the Decision to Operate. Issue 6 (December 2016)

• Record Type: Journal Article
• Authors: Sacks, Greg D.; Dawes, Aaron J.; Ettner, Susan L.; Brook, Robert H.; Fox, Craig R.; Maggard-Gibbons, Melinda; Ko, Clifford Y.; Russell, Marcia M.
• Is Part Of: Annals of surgery. Volume 264:Issue 6(2016:Dec.)
• Publication Date: 2016-12
• Subjects: behavioral science: perception -- risk and benefit -- surgical decision making -- variations; Surgery -- Periodicals; 617.005
• DOI: 10.1097/SLA.0000000000001784
• Languages: English
• ISSNs: 0003-4932

Abstract

Abstract : Objective: To determine how surgeons' perceptions of treatment risks and benefits influence their decisions to operate. Background: Little is known about what makes one surgeon choose to operate on a patient and another chooses not to operate. Methods: Using an online study, we presented a national sample of surgeons (N = 767) with four detailed clinical vignettes (mesenteric ischemia, gastrointestinal bleed, bowel obstruction, appendicitis) where the best treatment option was uncertain and asked them to: (1) judge the risks (probability of serious complications) and benefits (probability of recovery) for operative and nonoperative management and (2) decide whether or not they would recommend an operation. Results: Across all clinical vignettes, surgeons varied markedly in both their assessments of the risks and benefits of operative and nonoperative management (narrowest range 4%–100% for all four predictions across vignettes) and in their decisions to operate (49%–85%). Surgeons were less likely to operate as their perceptions of operative risk increased [absolute difference (AD) = –29.6% from 1.0 standard deviation below to 1.0 standard deviation above mean (95% confidence interval, CI: –31.6, –23.8)] and their perceptions of nonoperative benefit increased [AD = –32.6% (95% CI: –32.8, –-28.9)]. Surgeons were more likely to operate as their perceptions of operative benefit increased [AD = 18.7% (95% CI: 12.6, 21.5)] and their perceptions of nonoperative risk increased [AD = 32.7% (95% CI: 28.7, 34.0)]. Differences in risk/benefit perceptions explained 39% of the observed variation in decisions to operate across the four vignettes. Conclusions: Given the same clinical scenarios, surgeons' perceptions of treatment risks and benefits vary and are highly predictive of their decisions to operate. Abstract : Supplemental Digital Content is available in the text