Might Doctors Really "Know Best"?: Utilizing Surgeon Intuition to Strengthen Preoperative Surgical Risk Assessment

Many clinical factors are known to increase an individual patient's risk of perioperative complications and hospital readmission. Several novel risk calculators have been created to predict the risk of postoperative complications for specific procedures that rely entirely on objective measurements. Our goal was to determine if surgeon intuition (an estimate of the percent likelihood of minor and major medical and surgical complications and 30-day readmission) could provide an additional source of data in the preoperative setting that may enhance the prediction of complications after surgery.

We targeted the operative practices of three subspecialized orthopedic surgeons over a 6-month period (February 1 to July 31, 2015). We administered surveys to attending surgeons and assisting residents or nurse practitioners prior to each operation. Surgeons were asked to predict each patient's likelihood, on a scale from <1-100, for experiencing a complication. Following the procedure, we analyzed each patient's electronic medical record to determine any adverse events and readmissions. We then looked at levels of association between predictor variables and complications. Analysis of maximum likelihood estimates for complication outcome was performed comparing objective variables and surgeon prediction.

A total of 417 surveys in 270 patients were available for analysis. Defining the predicted likelihood of minor medical complications as <10% (low), 10-40% (intermediate), and >40% (high), provided discrimination of postoperative complications for a single observer in the first three month. These cutoff ranges showed inter-observer consistency and a trend towards intra-observer consistency. The only three variables predictive of minor medical complications were ASA class (OR=3.63, 95%CI=1.76-7.52, p=0.0005; comparing >2 vs ≤2), age (β=0.034±0.012, p=0.0032) and surgeon prediction when comparing high to low risk (β=0.034±0.008 (0.018-0.049), p<0.0001).

Quantitative surgeon preoperative risk assessment was able to accurately discriminate between low- and high-risk groups of minor medical complications. We did not find a similar association between major complications and readmissions.Level of Evidence: IV.