手术决策的决定因素：一项全国性调查。
Determinants of surgical decision making: a national survey.
机构信息
Robert Wood Johnson Clinical Scholars Program, Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Boulevard, West Pavilion, 3rd Floor, Philadelphia, PA 19104, USA; Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
出版信息
Am J Surg. 2013 Dec;206(6):970-7; discussion 977-8. doi: 10.1016/j.amjsurg.2013.08.018.
BACKGROUND
We conducted a national survey of general surgeons to address the association between surgeon characteristics and the tendency to recommend surgery.
METHODS
We used a web-based survey with 25 hypothetical clinical scenarios with clinical equipoise regarding the decision to operate. The respondent-level tendency to operate (TTO) score was calculated as the average score over the 25 scenarios. Surgical volume was based on self-report. Linear regression models were used to evaluate the associations between TTO, other covariates of interest, and surgical volume.
RESULTS
There were 907 respondents. The mean surgical TTO was 3.05 ± .43. Surgeons had significantly lower TTO scores when responding to questions within their area of practice (P < .0001). There was no association between TTO and malpractice concerns, financial incentives, or compensation structure.
CONCLUSIONS
Surgeons recommend intervention far less frequently within their area of specialization. Malpractice concerns, volume, and financial compensation do not significantly affect surgical decision making.
背景
我们对普通外科医生进行了一项全国性调查，以探讨外科医生特征与推荐手术倾向之间的关系。
方法
我们使用了一个基于网络的调查，其中包含 25 个关于手术决策的临床均衡假设临床情况。受访者的手术倾向 (TTO) 评分是通过对 25 个场景的平均评分计算得出的。手术量基于自我报告。线性回归模型用于评估 TTO 与其他感兴趣的协变量以及手术量之间的关联。
结果
共有 907 名受访者。平均手术 TTO 为 3.05 ±.43。当外科医生回答他们专业领域内的问题时，他们的 TTO 得分明显较低（P <.0001）。TTO 与医疗事故担忧、经济激励或薪酬结构之间没有关联。
结论
外科医生在其专业领域内推荐干预的频率要低得多。医疗事故担忧、手术量和经济补偿并没有显著影响手术决策。
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