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J Surg Res. 2016 Oct;205(2):378-383. doi: 10.1016/j.jss.2016.06.075. Epub 2016 Jul 4.

Assessing surgeon behavior change after anastomotic leak in colorectal surgery.

Author information

1
Department of Surgery, University of Washington, Seattle, Washington. Electronic address: vsimianu@uw.edu.
2
Department of Health Services, University of Washington, Seattle, Washington.
3
Department of Surgery, Surgical Outcomes Research Center, University of Washington, Seattle, Washington.
4
Department of Surgery, Virginia Mason Medical Center, Seattle, Washington.
5
Department of Global Health, Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington.
6
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.

Abstract

BACKGROUND:

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.

MATERIALS AND METHODS:

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.

RESULTS:

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.

CONCLUSIONS:

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.

KEYWORDS:

Anastomotic leak; Colon and rectal surgery; Decision making; Leak testing; Recency effect

PMID:
27664886
PMCID:
PMC5065263
DOI:
10.1016/j.jss.2016.06.075
[Indexed for MEDLINE]
Free PMC Article

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