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Area of Science:

  • Surgical decision-making
  • Emergency medicine
  • Patient outcomes

Background:

  • Over 30,000 emergency laparotomies are performed annually in England and Wales.
  • These procedures have high morbidity and an 11% 30-day mortality rate.
  • Decision-making regarding surgery significantly impacts patient outcomes.

Purpose of the Study:

  • To investigate the decision-making process for emergency laparotomies.
  • To identify factors influencing these critical surgical decisions.
  • To explore differences in decision-making among surgical staff.

Main Methods:

  • Mixed-methods study combining semi-structured interviews and an online survey.
  • Interviews with general surgeons informed survey design.
  • Survey included vignettes to assess decision-making based on surgeon grade, risk attitudes, and experience.

Main Results:

  • Key decision-making factors include patient, surgeon, and external elements.
  • Non-consultant surgeons were more likely to perform emergency laparotomies than consultants.
  • No significant association found between operative decisions and risk attitudes, reflective practice, or prior experiences.

Conclusions:

  • Decision-making in emergency laparotomy directly influences patient outcomes.
  • A disparity exists in decision-making and risk attitudes between consultant and junior surgeons.
  • Recommends formal training in decision-making models and case discussions for surgical trainees.