Predictive accuracy of surgeon gestalt for adverse postoperative outcomes: systematic review

Risk assessment plays an important role in surgical decision-making. To estimate complication risk, many surgeons rely on gestalt, a mental process that involves integrating a range of clinical information. Others utilize dedicated risk scoring tools, which offer more standardized assessments. The aims of this systematic review were to explore the current evidence on the predictive value of gestalt for adverse postoperative events and to compare gestalt prediction with various scoring tools.

This systematic review was conducted following the PRISMA 2020 guidelines and the Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy. MEDLINE, Embase, Scopus, ClinicalTrials.gov, ACM digital library, and IEEE Xplore databases were searched. Studies concerned with surgeon gestalt prediction of adverse postoperative outcomes were included. Risk of bias was assessed using the QUADAS-2 tool. Outcomes evaluated were gestalt and scoring tool predictive accuracies for mortality and morbidity. A narrative synthesis was conducted.

A total of 34 studies encompassing 33 657 patients were included. Surgeons had good discrimination when predicting mortality, but consistently overestimated risk. Scoring tools generally outperformed surgeons, but integrated tools incorporating both gestalt and scoring tool outputs performed best. There was some evidence that gestalt accuracy improved with surgeon experience. Surgeons may also be better at predicting complications for elective procedures compared with emergency procedures.

Surgeon gestalt can be a valuable predictor of surgical outcomes both on its own and as a component of integrated risk scoring tools. Future studies should aim to elucidate what factors contribute to effective gestalt assessment.