Assessing surgeon behavior change after anastomotic leak in colorectal surgery

Vlad V. Simianu, Anirban Basu, Rafael Alfonso-Cristancho, Richard C. Thirlby, Abraham D. Flaxman, David R. Flum

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Background Recency effect suggests that people disproportionately value events from the immediate past when making decisions, but the extent of this impact on surgeons' decisions is unknown. This study evaluates for recency effect in surgeons by examining use of preventative leak testing before and after colorectal operations with anastomotic leaks. Materials and methods Prospective cohort of adult patients (≥18 y) undergoing elective colorectal operations at Washington State hospitals participating in the Surgical Care and Outcomes Assessment Program (2006-2013). The main outcome measure was surgeons' change in leak testing from 6 mo before to 6 mo after an anastomotic leak occurred. Results Across 4854 elective colorectal operations performed by 282 surgeons at 44 hospitals, there was a leak rate of 2.6% (n = 124). The 40 leaks (32%) in which the anastomosis was not tested occurred across 25 surgeons. While the ability to detect an overall difference in use of leak testing was limited by small sample size, nine (36%) of 25 surgeons increased their leak testing by 5% points or more after leaks in cases where the anastomosis was not tested. Surgeons who increased their leak testing more frequently performed operations for diverticulitis (45% versus 33%), more frequently began their cases laparoscopically (65% versus 37%), and had longer mean operative times (195 ± 99 versus 148 ± 87 min), all P < 0.001. Conclusions Recency effect was demonstrated by only one-third of eligible surgeons. Understanding the extent to which clinical decisions may be influenced by recency effect may be important in crafting quality improvement initiatives that require clinician behavior change.

Original languageEnglish (US)
Pages (from-to)378-383
Number of pages6
JournalJournal of Surgical Research
Issue number2
StatePublished - Oct 1 2016

Bibliographical note

Funding Information:
Research reported in this publication was carried out under the Comparative Effectiveness Research Translation Network's Collaborative for Healthcare Research in Behavioral Economics and Decision Sciences (CERTAIN-CHOICES). CERTAIN is a program of the University of Washington. Research reported in this publication was supported by the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health under Award Number T32DK070555 and by the University of Washington's Department of Surgery Research Reinvestment Fund. The Surgical Care and Outcomes Assessment Program (SCOAP) is a Coordinated Quality Improvement Program of the Foundation for Health Care Quality. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health (grant number: T32DK070555), Foundation for Health Care Quality, or the University of Washington Medical Center's Department of Surgery.

Publisher Copyright:
© 2016 Elsevier Inc.


  • Anastomotic leak
  • Colon and rectal surgery
  • Decision making
  • Leak testing
  • Recency effect


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