Risk preferences and attitudes to surgery in decision making

Area of Science:

• Orthopedic Surgery
• Medical Decision Making
• Health Psychology

Background:

• Evidence suggests some surgeries offer minimal benefit over nonoperative treatments.
• Physician optimism may lead to inappropriate surgical recommendations.
• Understanding factors influencing treatment choice is crucial.

Purpose of the Study:

• To investigate the influence of risk attitudes on orthopedic surgeons' treatment choices.
• To determine if risk aversion correlates with opting for nonoperative management.
• To explore other hazardous surgical attitudes impacting treatment decisions.

Main Methods:

• Online survey of 946 Swedish orthopedic surgeons.
• Presentation of a proximal humeral fracture case with patient variations.
• Surgeons chose between operative and nonoperative treatments.
• Assessment of economic risk preference and hazardous surgical attitudes.
• Regression analysis to identify associations.

Main Results:

• 388 surgeons responded; 64 preferred nonoperative treatment for all cases.
• No significant association found between risk aversion and avoiding surgery.
• A "macho" attitude or resignation correlated with choosing operative treatment.
• Extensive surgical experience was linked to choosing nonoperative treatment.

Conclusions:

• Discrepancy between surgical evidence and practice is linked to hazardous attitudes, not risk preference.
• Nonoperative treatment choice is associated with surgeon experience and a sense of control.
• Enhanced awareness of surgical evidence is needed to align practice with indications.