Assessing surgeon behavior change after anastomotic leak in colorectal surgery.
Recency effect suggests that people disproportionately value events from the immediate past when making decisions, but the extent of this impact on surgeons' decisions is unknown. This study evaluates for recency effect in surgeons by examining use of preventative leak testing before and after colorectal operations with anastomotic leaks.



Prospective cohort of adult patients (≥18 y) undergoing elective colorectal operations at Washington State hospitals participating in the Surgical Care and Outcomes Assessment Program (2006-2013). The main outcome measure was surgeons' change in leak testing from 6 mo before to 6 mo after an anastomotic leak occurred.



Across 4854 elective colorectal operations performed by 282 surgeons at 44 hospitals, there was a leak rate of 2.6% (n = 124). The 40 leaks (32%) in which the anastomosis was not tested occurred across 25 surgeons. While the ability to detect an overall difference in use of leak testing was limited by small sample size, nine (36%) of 25 surgeons increased their leak testing by 5% points or more after leaks in cases where the anastomosis was not tested. Surgeons who increased their leak testing more frequently performed operations for diverticulitis (45% versus 33%), more frequently began their cases laparoscopically (65% versus 37%), and had longer mean operative times (195 ± 99 versus 148 ± 87 min), all P < 0.001.



Recency effect was demonstrated by only one-third of eligible surgeons. Understanding the extent to which clinical decisions may be influenced by recency effect may be important in crafting quality improvement initiatives that require clinician behavior change.
Department of Surgery, University of Washington, Seattle, Washington. Electronic address: vsimianu@uw.edu.
Vlad V
VV
Simianu
Department of Health Services, University of Washington, Seattle, Washington.
Anirban
A
Basu
Department of Surgery, Surgical Outcomes Research Center, University of Washington, Seattle, Washington.
Rafael
R
Alfonso-Cristancho
Department of Surgery, Virginia Mason Medical Center, Seattle, Washington.
Richard C
RC
Thirlby
Department of Global Health, Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington.
Abraham D
AD
Flaxman
Department of Surgery, University of Washington, Seattle, Washington; Department of Surgery, Surgical Outcomes Research Center, University of Washington, Seattle, Washington. Electronic address: daveflum@uw.edu.
David R
DR
Flum
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057868:Anastomotic Leak / Q000175:diagnosis* / Q000517:prevention & control*; D000066491:Clinical Decision-Making; D003106:Colon / Q000601:surgery*; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012007:Rectum / Q000601:surgery*; D066231:Surgeons / Q000523:psychology*; D014861:Washington; D055815:Young Adult
Anastomotic leak; Colon and rectal surgery; Decision making; Leak testing; Recency effect
Med Decis Making. 2015 May;35(4):539-57
25145577
JAMA. 2005 Jun 1;293(21):2609-17
15928282
Int J Nurs Stud. 2001 Oct;38(5):591-9
11524105
Br J Surg. 2013 Dec;100(13):1748-55
24227360
Qual Saf Health Care. 2003 Jun;12(3):221-6; discussion 227-8
12792014
PLoS One. 2014 Jan 13;9(1):e85042
24454788
BMJ. 2006 Jan 21;332(7534):141-5
16403771
J Am Coll Surg. 2006 Nov;203(5):642-52
17084325
Annu Rev Public Health. 2013;34:431-47
23297657
Science. 1974 Sep 27;185(4157):1124-31
17835457
Arch Surg. 2012 Apr;147(4):345-51
22508778
J Clin Epidemiol. 1992 Jun;45(6):613-9
1607900