How do surgeons' probability estimates of operative mortality compare with a decision analytic model?

Area of Science:

• Cardiovascular Surgery
• Medical Decision Making
• Health Informatics

Background:

• Abdominal aortic aneurysms (AAA) pose significant surgical risks.
• Accurate operative mortality estimation is crucial for patient management.
• Surgeons' clinical judgment in predicting AAA outcomes is under scrutiny.

Purpose of the Study:

• To compare surgeon estimates of operative mortality for abdominal aortic aneurysms (AAA) with a decision analytic model.
• To evaluate how surgeons utilize clinical information in their risk assessments.
• To assess the accuracy and discrimination capabilities of both surgeons and the model.

Main Methods:

• Four experienced surgeons estimated operative mortality for 137 AAA patients.
• A decision analytic model calculated operative mortality based on patient data.
• Surgeons' risk assessments were compared against model-derived mortalities and actual outcomes.

Main Results:

• Surgeons' average mortality estimates were comparable to the model's calculations.
• Surgeons showed less ability than the model in differentiating high-risk from low-risk patients.
• Significant inconsistencies were observed in how surgeons weighed clinical information compared to the model.

Conclusions:

• While surgeons' average estimates are accurate, decision models offer better risk stratification for abdominal aortic aneurysms (AAA).
• The complexity of predicting surgical outcomes influences physician performance.
• Decision models can serve as valuable learning tools to enhance surgeons' risk assessment skills.