Personalized decision-making for acute cholecystitis: Understanding surgeon judgment.

Area of Science:

• Gastroenterology
• Surgical Decision-Making
• Health Informatics

Background:

• Limited high-level evidence exists for managing severe acute cholecystitis.
• Treatment decisions rely heavily on surgeon judgment, leading to variability.
• This study investigates potential misalignments in surgeon recommendations for surgical interventions.

Purpose of the Study:

• To test the hypothesis that surgeons' treatment recommendations for acute cholecystitis misalign with perceived risks and benefits.
• To compare surgeon perceptions of laparoscopic cholecystectomy versus percutaneous cholecystostomy.
• To identify opportunities for data-driven decision support in surgical practice.

Main Methods:

• A web-based survey was administered to surgeons (attendings, fellows, residents).
• Participants estimated risks and benefits of laparoscopic cholecystectomy vs. percutaneous cholecystostomy for moderate and severe acute cholecystitis.
• Surgeons indicated their likelihood of recommending cholecystectomy.

Main Results:

• Surgeons predicted similar morbidity for both procedures but perceived lower recovery rates with percutaneous cholecystostomy.
• A high likelihood of recommending cholecystectomy for moderate cholecystitis (98%) contrasted with severe cases (32%).
• Recommendations for severe cholecystitis were discordant with perceived benefits, with only 32% recommending cholecystectomy despite predicting better recovery.

Conclusions:

• Surgeon recommendations for severe acute cholecystitis do not align with their risk-benefit assessments.
• A significant gap exists between predicted functional recovery and actual treatment recommendations.
• Personalized, data-driven decision support tools could enhance surgical decision-making for acute cholecystitis.