Risky business: The biggest factor in whether a surgeon will operate is 'disturbing,' expert says

Clinicians need more tools to assist with decision-making, Jha says

Individual surgeons have drastically different perceptions of risk that can significantly affect how likely they are to recommend surgery to a patient, according to a new study in Annals of Surgery.     

Second opinions are an important source of guidance for patients—but they can also cause significant anxiety. One surgeon may say an operation is impossible, unnecessary, or overly risky, while another could push to operate immediately.

Details of the study

The new study in Annals of Surgery asks why surgeons' opinions can vary and comes away with a slightly unsettling conclusion: It just depends on how individual surgeons think about risk, Julia Belluz reports for Vox.

For the study, researchers from the University of California, Los Angeles (UCLA) asked more than 750 surgeons to review four hypothetical cases, evaluate the risks, and recommend next steps. The cases included detailed clinical scenarios related to mesenteric ischemia, gastrointestinal bleeding, bowel obstruction, and appendicitis. None of the best treatment options was "obvious," according to a release.

Despite reviewing the same evidence, in approximately 75 percent of cases surgeons divided on whether or not to operate. For instance, in one scenario a 19-year-old presented with pain in the right lower abdomen and fevers, suggesting appendicitis. About half of the surgeons recommended operating—while the other half suggested non-surgical treatments.

The difference in opinions seems to be determined by individual surgeon's perception of risk and reward. "Surgeons were more likely to operate as their perceptions of operative benefit increased and their perceptions of nonoperative risk increased," the authors wrote. However, according to the study, surgeon's perceptions of risk varied by as much as 100 percent.

Context and recommendations

Ashish Jha, a Harvard University professor of health policy, says the findings are both "enormously important" and "disturbing." Humans, he explains, are poor judges of risk, and "even surgeons are not able to escape these deeply human deficiencies."

Providers see surge in second opinions

Tools exist to help surgeons better judge risk, Belluz notes. One  risk calculator developed by the American College of Surgeons, for instance, uses data from millions of patients to help surgeons evaluate more objectively the dangers of operating.

Greg Sacks, a surgical resident at UCLA and lead author of the study, also evaluated the effect of that risk calculator in a separate study. He found that use of the tool reduced variation among surgeons' risk calculations—but even so, the tool did little to sway whether they chose to operate.

Jha says the results from the risk calculator study show such tools can be valuable. "It's clear we need to develop more resources like this to be additional input beyond personal experience for surgical decision-making," he explains (Belluz, Vox, 5/19; UCLA release, 5/19).

How to advance evidence-based practice at your organization

Many CMOs tell us they're putting a lot of effort into creating and implementing evidence-based guidelines, but they're not seeing the expected yield. In other words, EBP activity is not yet producing success, and CMOs report a range of issues standing in their way.

This briefing equips physician and quality leaders with strategies and tools to accelerate evidence-based practice adoption at their organizations.

Download the study

Next in the Daily Briefing

Hospitals praise bill that would alter Medicare payment policies

Read now