title: The use of multi-criteria decision making models in evaluating anesthesia method options in circumcision surgery.
abstract: BACKGROUND
  Determining the most suitable anesthesia method for circumcision surgery plays a fundamental role in pediatric surgery. This study is aimed to present pediatric surgeons' perspective on the relative importance of the criteria for selecting anesthesia method for circumcision surgery by utilizing the multi-criteria decision making methods.
  
  
  METHODS
  Fuzzy set theory offers a useful tool for transforming linguistic terms into numerical assessments. Since the evaluation of anesthesia methods requires linguistic terms, we utilize the fuzzy Analytic Hierarchy Process (AHP) and fuzzy Technique for Order Preference by Similarity to Ideal Solution (TOPSIS). Both mathematical decision-making methods are originated from individual judgements for qualitative factors utilizing the pair-wise comparison matrix. Our model uses four main criteria, eight sub-criteria as well as three alternatives. To assess the relative priorities, an online questionnaire was completed by three experts, pediatric surgeons, who had experience with circumcision surgery.
  
  
  RESULTS
  Discussion of the results with the experts indicates that time-related factors are the most important criteria, followed by psychology, convenience and duration. Moreover, general anesthesia with penile block for circumcision surgery is the preferred choice of anesthesia compared to general anesthesia without penile block, which has a greater priority compared to local anesthesia under the discussed main-criteria and sub-criteria.
  
  
  CONCLUSIONS
  The results presented in this study highlight the need to integrate surgeons' criteria into the decision making process for selecting anesthesia methods. This is the first study in which multi-criteria decision making tools, specifically fuzzy AHP and fuzzy TOPSIS, are used to evaluate anesthesia methods for a pediatric surgical procedure.
authors.affiliation: School of Management, Centre of Operational Research, Management Sciences & Information Systems, University of Southampton, Southampton, UK. gulsahhancerliogullari@gmail.com.|Department of Industrial Engineering, Faculty of Management, Istanbul Technical University, Istanbul, Turkey. gulsahhancerliogullari@gmail.com.
authors.forename: Gulsah
authors.initials: G
authors.lastname: Hancerliogullari
authors.affiliation: Department of Pediatric Surgery, Faculty of Medicine, Giresun University, Giresun, Turkey.
authors.forename: Kadir Oymen
authors.initials: KO
authors.lastname: Hancerliogullari
authors.affiliation: Department of Industrial Engineering, Faculty of Management, Istanbul Technical University, Istanbul, Turkey.
authors.forename: Emrah
authors.initials: E
authors.lastname: Koksalmis
mesh_terms: D000758:Anesthesia / Q000592:standards*; D002944:Circumcision, Male / Q000592:standards*; D000066491:Clinical Decision-Making / Q000379:methods*; D017143:Fuzzy Logic; D006801:Humans; D008297:Male; D000072143:Pediatricians / Q000592:standards*; D066231:Surgeons / Q000592:standards*
keywords: AHP; Anesthesia methods; Circumcision surgery procedure; Fuzzy; Health care; Multi-criteria; TOPSIS