Heuristics and bias in rectal surgery.

Area of Science:

• Colorectal surgery
• Surgical decision-making
• Patient outcomes

Background:

• Deciding on defunctioning stomas after anterior resection involves complex cognitive processes.
• Previous studies identified surgeon age and risk-taking as biases affecting stoma creation in Australia and New Zealand.

Purpose of the Study:

• To evaluate surgeon age and risk-taking propensity as predictors of defunctioning stoma formation in British Isles colorectal surgeons.
• To identify additional cognitive biases influencing stoma creation decisions.

Main Methods:

• An online survey was distributed to members of the Association of Coloproctology of Great Britain and Ireland (ACPGBI).
• Survey questions covered demographics, risk tolerance, sensitivity to criticism, self-assessed anastomotic leak rates, and stoma formation propensity.
• Statistical analyses included Chi-squared testing and multiple regression to identify independent predictors of stoma formation.

Main Results:

• 150 ACPGBI surgeons responded; demographics were comparable to Australian/New Zealand surgeons.
• ACPGBI surgeons reported significantly higher anastomotic leak rates (p < 0.001).
• Independent predictors of less frequent stoma formation included surgeon age over 50, higher risk-taking propensity, belief in a lower-than-average anastomotic leak rate, and perceiving the average leak risk as 8% or less.

Conclusions:

• Surgeon-specific factors, including age, risk tolerance, and optimism bias regarding anastomotic leak rates, significantly influence the decision to create a defunctioning stoma.
• These unrecognised cognitive biases play a role in rectal surgery decision-making, potentially impacting patient management and outcomes.