Surgeon Perception of Risk and Benefit in the Decision to Operate
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.
Annals of surgery