title: Decision-making in rectal surgery.
abstract: OBJECTIVE
  The decision to create a stoma after anterior resection has significant consequences. Decisions under uncertainty are made with a variety of cognitive tools, or heuristics. Past experience has been shown to be a powerful heuristic in other domains. Our aim was to identify whether the misfortune of recent anastomotic leakage or surgeon propensity to take everyday risks would affect their decision to defunction a range of anastomoses.
  
  
  METHODS
  Questionnaires were sent to members of the Colorectal Surgical Society of Australia and New Zealand. Participants were asked for demographic information, questions regarding risk-taking propensity, when their last anastomotic leakage occurred and whether they would defunction a range of hypothetical rectal anastomoses grouped according to height, American Society of Anesthesiologists grade and use of preoperative radiotherapy. Scores were derived for hypothetical patient likelihood of having a stoma created and individual surgeon propensity for stoma formation. Hazard regression analysis was used to assess demographic predictors of stoma formation.
  
  
  RESULTS
  In total, 110 (75.3%) of 146 surveyed surgeons replied; 72 (65.5%) reported anastomotic leakage within the last 12 months. Surgeons' propensity for risk-taking was comparable (24.6 vs 27.53, 95% confidence interval, Mann-Whitney-U) to previously studied participants in economic models. Surgeon age (< 50 years) and lower propensity for risk-taking were demonstrated to be independent predictors of stoma formation on regression analysis.
  
  
  CONCLUSIONS
  Although the decision to create a stoma after anterior resection may be made in the belief that its foundation derives from rational thought, it appears that other unrecognized operator factors such as age and risk-taking exert an effect.
authors: Department of Surgery, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.
authors: E
authors: E
authors: MacDermid
authors: C J
authors: CJ
authors: Young
authors: J
authors: J
authors: Young
authors: M
authors: M
authors: Solomon
mesh_terms: D000328:Adult; D000367:Age Factors; D000714:Anastomosis, Surgical / Q000379:methods; D057868:Anastomotic Leak / Q000453:epidemiology / Q000517:prevention & control*; D001291:Attitude of Health Personnel; D003107:Colorectal Surgery; D003657:Decision Making; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D007081:Ileostomy / Q000379:methods; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012004:Rectal Neoplasms / Q000601:surgery*; D012007:Rectum / Q000601:surgery*; D012309:Risk-Taking; D011795:Surveys and Questionnaires
keywords: Heuristics; rectal surgery; stoma