是否进行手术？一项关于急诊手术决策的多方法分析。

To operate or not to operate? A multi-method analysis of decision-making in emergency surgery.

机构信息

Department of Biosurgery and Surgical Technology, Imperial College of Medicine, London, UK.

出版信息

Am J Surg. 2010 Aug;200(2):298-304. doi: 10.1016/j.amjsurg.2009.10.020. Epub 2010 Apr 14.

DOI:10.1016/j.amjsurg.2009.10.020

PMID:20392432

Abstract

BACKGROUND

The ability to decide when to operate and when not to operate is a key surgical skill. The aim of this study was to investigate factors affecting that decision.

METHODS

In phase 1, semistructured interviews were used to investigate how expert surgeons decide when to operate. In phase 2, clinical case vignettes were constructed, and 22 general surgeons at various stages of their training indicated whether they would operate and their confidence in patient outcomes.

RESULTS

Interviews answers centered on the theme of "patient outcome," which was defined similarly by all surgeons. In phase 2, surgeons chose to operate when they perceived the outcome with an operation to be better than the outcome without. Surgeons with <5 years of experience were less certain about what outcomes might be. These surgeons opted to perform significantly more operations (40 +/- 4%) than surgeons with > or =5 years of experience (18 +/- 2%).

CONCLUSIONS

A subjective, balanced assessment of the likelihood of patient outcome is crucial in deciding whether to operate. Novices face higher degrees of uncertainty, explaining differences in decisions taken.

摘要

背景

能够决定何时进行手术以及何时不进行手术是一项关键的外科技能。本研究旨在探讨影响这一决策的因素。

方法

在第 1 阶段，采用半结构化访谈的方式调查专家外科医生如何决定何时进行手术。在第 2 阶段，构建了临床病例情景，22 名处于不同培训阶段的普通外科医生表示他们是否会进行手术以及对患者结局的信心。

结果

访谈答案集中在“患者结局”这一主题上，所有外科医生对其定义相似。在第 2 阶段，当外科医生认为手术的结果比不手术的结果更好时，他们选择进行手术。经验不足 5 年的外科医生对可能的结果不太确定。这些外科医生选择进行的手术明显多于经验丰富（>=5 年）的外科医生（40 +/- 4% vs 18 +/- 2%）。