Exploring variation in surgical practice : does the surgeon's personality influence anastomotic decision-making?'

Funding This work was kindly supported by Bowel Research UK and the Ileostomy and Internal Pouch Association. The funders had no influence in the design, delivery, or interpretation of this study. Acknowledgements The study authors are grateful to all participants who took part, as well as those individuals and professional bodies who shared the Plato Project survey, including: the Association of Coloproctology of Great Britain and Ireland, the COVIDSurg Collaborative Group, the Turkish Society of Colon and Rectal Surgery and the Italian Surgical Research Group.Peer reviewedPublisher PD

BJS Prize 2 Exploring variation in surgical practice: the colorectal surgeon's personality influences anastomotic decision-making in rectal cancer

Background The influence of internal surgeon-specific factors, such as personality, on cognitive bias and decision-making in surgery is not well understood. These factors may be particularly influential in clinical cases where there is a high degree of equipoise. This study aimed to explore personality traits that may influence anastomotic decision-making in rectal cancer. Methods Colorectal surgeons were invited via social media to participate in a 2-part online survey (Snap11). The survey included: 1) 44-item Big Five Inventory (personality), 2) 30-item DOSPERT (risk-taking), 3) 3-item Cognitive Reflection Test (thinking style), and twenty hypothetical patient scenarios involving rectal anastomotic decisions. Results 186 certified colorectal surgeons participated with 127 completing both parts (68.3%). 143 participants in this cohort were aged 30–49 years (79.6%) and 131 participants were male (70.4%). Surgeons scored higher than average population levels for emotional stability (degree of even-temperedness; 3.25 vs 2.97), with lower levels of agreeableness (ability to cooperate with others; 3.03 vs 3.74) and openness (creativity; 3.19 vs 3.67). Personality influenced anastomotic decision-making in specific circumstances e.g., high levels of openness predicted stoma formation when providing a second opinion, whereas high levels of extraversion predicted stoma formation when the patient was a staff member. Early career surgeons were highly influenced by colleague criticism following recent anastomotic leakage. Conclusions Surgeon personality influences anastomotic decision-making in difficult circumstances. Colleague support is vital following anastomotic leakage and is influential upon early career surgeons’ subsequent decision-making. Personality is modifiable through experiences, therefore targeted educational interventions (e.g. reflexivity) may enable surgeons to recognize their own cognitive biases

Exploring variation in surgical practice: does surgeon personality influence anastomotic decision-making?

Background: Decision-making under uncertainty may be influenced by an individual’s personality. The primary aim was to explore associations between surgeon personality traits and colorectal anastomotic decision-making. Methods: Colorectal surgeons worldwide participated in a two-part online survey. Part 1 evaluated surgeon characteristics using the Big Five Inventory to measure personality (five domains: agreeableness; conscientiousness; extraversion; emotional stability; openness) in response to scenarios presented in Part 2 involving anastomotic decisions (i.e. rejoining the bowel with/without temporary stomas, or permanent diversion with end colostomy). Anastomotic decisions were compared using repeated-measure ANOVA. Mean scores of traits domains were compared with normative data using two-tailed t tests. Results: In total, 186 surgeons participated, with 127 surgeons completing both parts of the survey (68.3 per cent). One hundred and thirty-one surgeons were male (70.4 per cent) and 144 were based in Europe (77.4 per cent). Forty-one per cent (77 surgeons) had begun independent practice within the last 5 years. Surgeon personality differed from the general population, with statistically significantly higher levels of emotional stability (3.25 versus 2.97 respectively), lower levels of agreeableness (3.03 versus 3.74), extraversion (2.81 versus 3.38) and openness (3.19 versus 3.67), and similar levels of conscientiousness (3.42 versus 3.40 (all P <0.001)). Female surgeons had significantly lower levels of openness (P <0.001) than males (3.06 versus 3.25). Personality was associated with anastomotic decision-making in specific scenarios. Conclusion: Colorectal surgeons have different personality traits from the general population. Certain traits seem to be associated with anastomotic decision-making but only in specific scenarios. Further exploration of the association of personality, risk-taking, and decision-making in surgery is necessary

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially