To operate or not to operate? A multi-method analysis of decision-making in emergency surgery.
BACKGROUND
The ability to decide when to operate and when not to operate is a key surgical skill. The aim of this study was to investigate factors affecting that decision.


METHODS
In phase 1, semistructured interviews were used to investigate how expert surgeons decide when to operate. In phase 2, clinical case vignettes were constructed, and 22 general surgeons at various stages of their training indicated whether they would operate and their confidence in patient outcomes.


RESULTS
Interviews answers centered on the theme of "patient outcome," which was defined similarly by all surgeons. In phase 2, surgeons chose to operate when they perceived the outcome with an operation to be better than the outcome without. Surgeons with <5 years of experience were less certain about what outcomes might be. These surgeons opted to perform significantly more operations (40 +/- 4%) than surgeons with > or =5 years of experience (18 +/- 2%).


CONCLUSIONS
A subjective, balanced assessment of the likelihood of patient outcome is crucial in deciding whether to operate. Novices face higher degrees of uncertainty, explaining differences in decisions taken.
Szatmary
Peter
P
Department of Biosurgery and Surgical Technology, Imperial College of Medicine, London, UK. dr.szatmary@doctors.net.uk
Arora
Sonal
S
Sevdalis
Nick
N
D001291:Attitude of Health Personnel; D002983:Clinical Competence; D003657:Decision Making; D004630:Emergencies; D006801:Humans; D007407:Interviews as Topic; D007600:Judgment; D010820:Physicians / Q000523:psychology*; D013514:Surgical Procedures, Operative / Q000523:psychology*; D016896:Treatment Outcome