CHICAGO: Preoperative surgeon intuition is an independent predictor of 30-day postoperative complications; however, when compared to the standard risk calculator derived from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP®), its predictive power isn’t as strong, according to a study published in the Journal of the American College of Surgeons (JACS).
Surgeons weigh many different factors, such as medical history and current health status, when deciding what type of surgery to perform. A physician’s intuition—training, past experiences, and their “gut” feeling about a patient—also plays a role in the assessment.
However, even when the diagnosis is the same, there is still significant variability in physician decision-making. According to one study, patients seeking a second opinion only receive the same diagnosis from both physicians about 12% of the time.*
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“The integration of the explicit, the intangible, and experience together form what we call surgeon intuition. Surgeons with a certain level of training and experience will have relatively similar intuition in certain cases,” said senior study author Gabriel A. Brat, MD, MPH, FACS, a trauma surgeon and assistant professor of surgery at Beth Israel Deaconess Medical Center and Harvard Medical School. “However, intuition is dynamic. It depends on the characteristics of the provider. One surgeon can see one patient and believe one thing about that patient’s outcome, and another surgeon can see the same patient and predict a different outcome.”
For the study, researchers sought to quantify the value of intuition in predicting outcomes among surgical patients. They investigated whether preoperative intuition could be used in risk prediction in a similar way that the ACS NSQIP Surgical Risk Calculator is currently used. The NSQIP Risk Calculator is a tool used to estimate patient-specific postoperative complication risks for almost all operations and includes a surgeon intuition adjustment.
“We wanted to know if it’s possible to adjust for intuition in a more precise way,” said Jayson S. Marwaha, MD, MBI, lead study author and general surgery resident at Georgetown University.
The researchers developed a new algorithm that predicts postoperative outcomes using surgeon preoperative intuition alone. To do this, researchers surveyed general surgeons between October 2021 and September 2022 at Beth Israel Deaconess Medical Center right before starting their surgery. A one-question text message asked them to predict the patient’s likelihood of having a negative outcome, specifically if the patient was lower than average risk, average risk, or higher than average risk for postoperative complications or death. In total, 216 patients were included in this analysis.
