Cognitive Biases and Heuristics in Surgical Settings: A Systematic Review

Area of Science:

• Medical decision-making
• Cognitive psychology
• Surgical safety

Background:

• Cognitive biases and heuristics are systematic thinking errors impacting clinical decisions.
• These biases are prevalent in surgical settings, posing risks to patient safety.
• Understanding these cognitive phenomena is crucial for improving surgical practice.

Purpose of the Study:

• To systematically review cognitive biases and heuristics in surgeons during operative settings.
• To determine the impact of these biases on patient care and surgical outcomes.

Main Methods:

• Systematic review adhering to PRISMA guidelines.
• Searched five major databases from inception to January 2024.
• Included original primary research studies in English, assessing risk of bias.

Main Results:

• Identified 38 cognitive biases across 21 studies.
• Confirmation bias, anchoring, risk aversion, and overconfidence bias were most frequent.
• Biases negatively impacted patient care in six studies, with one fatal outcome linked to biases.

Conclusions:

• Cognitive biases contribute to surgical errors and never events.
• Debiasing strategies like mindfulness and reflection show promise in reducing errors.
• Further experimental research is needed to understand bias mechanisms and evaluate interventions.