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Heuristics and bias in rectal surgery

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

Deciding to defunction after anterior resection can be difficult, requiring cognitive tools or heuristics. From our previous work, increasing age and risk-taking propensity were identified as heuristic biases for surgeons in Australia and New Zealand (CSSANZ), and inversely proportional to the likelihood of creating defunctioning stomas. We aimed to assess these factors for colorectal surgeons in the British Isles, and identify other potential biases.

Methods

The Association of Coloproctology of Great Britain and Ireland (ACPGBI) was invited to complete an online survey. Questions included demographics, risk-taking propensity, sensitivity to professional criticism, self-perception of anastomotic leak rate and propensity for creating defunctioning stomas. Chi-squared testing was used to assess differences between ACPGBI and CSSANZ respondents. Multiple regression analysis identified independent surgeon predictors of stoma formation.

Results

One hundred fifty (19.2%) eligible members of the ACPGBI replied. Demographics between ACPGBI and CSSANZ groups were well-matched. Significantly more ACPGBI surgeons admitted to anastomotic leak in the last year (p < 0.001). ACPGBI surgeon age over 50 (p = 0.02), higher risk-taking propensity across several domains (p = 0.044), self-belief in a lower-than-average anastomotic leak rate (p = 0.02) and belief that the average risk of leak after anterior resection is 8% or lower (p = 0.007) were all independent predictors of less frequent stoma formation. Sensitivity to criticism from colleagues was not a predictor of stoma formation.

Conclusions

Unrecognised surgeon factors including age, everyday risk-taking, self-belief in surgical ability and lower probability bias of anastomotic leak appear to exert an effect on decision-making in rectal surgery.

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Acknowledgements

The authors would like to thank the Association of Coloproctology of Great Britain and Ireland (ACPGBI) for their help and support with this work.

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Authors and Affiliations

  1. Department of Surgery, Nepean Hospital, Kingswood, NSW, Australia

    Ewan MacDermid

  2. Department of Colorectal Surgery, Royal Prince Alfred Hospital, Camperdown, NSW, Australia

    Christopher J. Young

  3. University of Sydney, Sydney, NSW, Australia

    Christopher J. Young & Heather L. Shepherd

  4. Department of Surgery, Royal Alexandra Hospital, Paisley, UK

    Susan J. Moug & Robert G. Anderson

Authors
  1. Ewan MacDermid
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  2. Christopher J. Young
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  3. Susan J. Moug
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  4. Robert G. Anderson
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  5. Heather L. Shepherd
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Corresponding author

Correspondence to Christopher J. Young.

Ethics declarations

Ethical approval was obtained from the Human Research Ethics Committee, Sydney Local Health District (ref LNR/14/RPAH/407), and the questionnaire was circulated with the assistance and support of the ACPGBI research board.

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MacDermid, E., Young, C.J., Moug, S.J. et al. Heuristics and bias in rectal surgery. Int J Colorectal Dis 32, 1109–1115 (2017). https://doi.org/10.1007/s00384-017-2823-7

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  • DOI: https://doi.org/10.1007/s00384-017-2823-7

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