title: Surgeons' attitudes are associated with reoperation and readmission rates.
abstract: BACKGROUND
  Attitudes influence how people make decisions. In an effort to decrease pilot judgment-related accidents, the Federal Aviation Administration teaches new pilots about hazardous attitudes that are believed to be incompatible with safe flight: macho, impulsive, worry, resignation, self-confidence, and antiauthority. If these attitudes are hazardous for pilots and their passengers, they may also be incompatible with the reliable and safe delivery of surgical care.
  
  
  OBJECTIVE
  The purposes of this study were (1) to ascertain to what extent surgeons harbor hazardous attitudes; and (2) to determine their relationship, if any, to reoperation and readmission rates.
  
  
  METHODS
  We selected validated aviation psychology tools that are used to measure these attitudes in pilots. We converted the aviation scenarios to analogous situations for surgeons and invited all surgeons from one academic program to participate in this study. A total of 41 surgeons were eligible to participate; 37 (90%) completed the attitude prevalence protocol and 31 (76%) had complete reoperation and readmission data for the correlation and regression analysis. Attending orthopaedic surgeons completed the Modified Surgeon Hazardous Attitude Scale as well as a series of additional instruments.
  
  
  RESULTS
  Levels of macho thought to be hazardous in pilots were present in nine (24%) surgeons. Similar, elevated levels of self-confidence were found in three (8%) surgeons. High levels of impulsivity were found in 5% (two surgeons) and high levels of antiauthority were found in 3% (one surgeon). Only one (3%) surgeon reported elevated levels of worry and no surgeon reported hazardous levels of resignation. Thirty percent (11 surgeons) of surgeons harbored at least one elevated attitude level. In a regression model, macho attitude levels predicted 19% of the variation in surgeons' rate of readmissions and reoperations.
  
  
  CONCLUSIONS
  High levels of hazardous attitudes may not be consistent with the routine delivery of safe surgical care in a teamwork setting where human factors and safe systems are the key to success. Further research is needed to determine if abnormally high levels of these hazardous attitudes impact patient care.
  
  
  METHODS
  Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.
authors.affiliation: Hand and Upper Extremity Surgery, South Shore Orthopedics, 2 Pond Park Road, Suite 102, Hingham, MA, 02043, USA, jkadzielski@partners.org.
authors.forename: John
authors.initials: J
authors.lastname: Kadzielski
authors.forename: Frank
authors.initials: F
authors.lastname: McCormick
authors.forename: James H
authors.initials: JH
authors.lastname: Herndon
authors.forename: Harry
authors.initials: H
authors.lastname: Rubash
authors.forename: David
authors.initials: D
authors.lastname: Ring
mesh_terms: D000060:Accidents, Aviation / Q000517:prevention & control; D001291:Attitude of Health Personnel; D001359:Aviation; D002755:Choice Behavior; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007175:Impulsive Behavior; D007398:Interpersonal Relations; D007600:Judgment; D019300:Medical Errors / Q000517:prevention & control / Q000523:psychology; D019637:Orthopedic Procedures / Q000009:adverse effects* / Q000523:psychology; D010348:Patient Care Team; D010359:Patient Readmission; D061214:Patient Safety; D011183:Postoperative Complications / Q000517:prevention & control / Q000523:psychology / Q000601:surgery*; D010818:Practice Patterns, Physicians'; D011594:Psychometrics; D012086:Reoperation; D018570:Risk Assessment; D012307:Risk Factors; D012309:Risk-Taking; D066231:Surgeons / Q000523:psychology*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D000078329:Workforce