Surgeon perception of risk and benefit in the decision to operate

Greg D. Sacks, Aaron J. Dawes, Susan L. Ettner, Robert H. Brook, Craig R. Fox, Melinda Maggard-Gibbons, Clifford Y. Ko, Marcia M. Russell

Research output: Contribution to journalArticlepeer-review

26 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)896-903
Number of pages8
JournalAnnals of surgery
Volume264
Issue number6
DOIs
StatePublished - Nov 28 2016

Keywords

  • Behavioral science: perception
  • Risk and benefit
  • Surgical decision making
  • vVariations

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