Surgeons' perceptions of risk of operations vary widely: study

Given the same clinical scenarios, surgeons came up with wildly different opinions on the potential risks and benefits, which was a major factor in their decision whether or not to operate.

In a study coauthored by Greg Sacks, MD, MPH, of the University of California Los Angeles and published in Annals of Surgery, more than 750 surgeons were provided four clinical vignettes and then asked to judge the risks and benefits of operative and nonoperative care. The four cases involved mesenteric ischemia, gastrointestinal bleed, bowel obstruction and appendicitis.

In three of the four cases, surgeons were nearly equally divided on recommending an operation. Even in the fourth case, which involved bowel obstruction in a 68-year-old patient, there wasn’t consensus, as 15 percent of the surgeons said the potential risks of operative management outweighed the benefits.

How surgeons perceived the risks and benefits appeared to be the most important factor in their decision.

“Surgeons were more likely to operate as their perceptions of operative benefit increased and their perceptions of nonoperative risk increased,” Sacks and coauthors wrote.

The opinions varied as widely as possible, however, with one surgeon perceiving no risk for a procedure, while another would judge the same procedure of having a 100 percent chance to leading to a major complication.

“These findings suggest that surgeons are possibly communicating to their patients very different estimates on the risks and benefits of treatment, and a patient's likelihood of getting surgery depends largely on how the surgeon happens to perceive these risks and benefits," Sacks said in a statement.

A potential solution was examined in a related study authored by Sacks using a risk calculator developed by the American College of Surgeons. This second study found using a such a tool led to less variation in risk assessment by surgeons, which may in turn lead to more informed discussions between surgeons and patients. In the end, however, Sacks found the risk calculator data “did not alter their reported likelihood of recommending an operation.”