Department of Surgery, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.
Colorectal Dis. 2014 Mar;16(3):203-8. doi: 10.1111/codi.12487.
The decision to create a stoma after anterior resection has significant consequences. Decisions under uncertainty are made with a variety of cognitive tools, or heuristics. Past experience has been shown to be a powerful heuristic in other domains. Our aim was to identify whether the misfortune of recent anastomotic leakage or surgeon propensity to take everyday risks would affect their decision to defunction a range of anastomoses.
Questionnaires were sent to members of the Colorectal Surgical Society of Australia and New Zealand. Participants were asked for demographic information, questions regarding risk-taking propensity, when their last anastomotic leakage occurred and whether they would defunction a range of hypothetical rectal anastomoses grouped according to height, American Society of Anesthesiologists grade and use of preoperative radiotherapy. Scores were derived for hypothetical patient likelihood of having a stoma created and individual surgeon propensity for stoma formation. Hazard regression analysis was used to assess demographic predictors of stoma formation.
In total, 110 (75.3%) of 146 surveyed surgeons replied; 72 (65.5%) reported anastomotic leakage within the last 12 months. Surgeons' propensity for risk-taking was comparable (24.6 vs 27.53, 95% confidence interval, Mann-Whitney-U) to previously studied participants in economic models. Surgeon age (< 50 years) and lower propensity for risk-taking were demonstrated to be independent predictors of stoma formation on regression analysis.
Although the decision to create a stoma after anterior resection may be made in the belief that its foundation derives from rational thought, it appears that other unrecognized operator factors such as age and risk-taking exert an effect.
前切除术（anterior resection）后造口的决定具有重要意义。在不确定的情况下，人们会使用各种认知工具或启发式方法做出决策。过去的经验已被证明是其他领域的有力启发式方法。我们的目的是确定近期吻合口漏（anastomotic leakage）的不幸事件或外科医生承担日常风险的倾向是否会影响他们对一系列吻合口进行功能障碍（defunction）的决定。
向澳大利亚和新西兰结直肠外科学会（Colorectal Surgical Society of Australia and New Zealand）的成员发送了问卷。参与者被要求提供人口统计学信息、风险承担倾向问题、他们最近一次吻合口漏发生的时间以及他们是否会对一系列假设的直肠吻合口进行功能障碍，这些吻合口根据高度、美国麻醉师协会（American Society of Anesthesiologists）分级和术前放疗的使用情况进行分组。为假设患者需要造口的可能性和每位外科医生形成造口的倾向创建了评分。风险回归分析用于评估人口统计学因素对造口形成的预测。
共调查了 146 名外科医生中的 110 名（75.3%）；72 名（65.5%）报告在过去 12 个月内发生吻合口漏。外科医生的风险承担倾向与经济模型中先前研究的参与者相当（24.6 比 27.53，95%置信区间，Mann-Whitney-U）。回归分析显示，外科医生年龄（<50 岁）和较低的风险承担倾向是造口形成的独立预测因素。
尽管前切除术（anterior resection）后造口的决定可能是基于理性思维做出的，但似乎还有其他未被认识到的操作者因素，如年龄和风险承担倾向，会产生影响。
