Aylmore Holly, Agarwal Srishti, Marcus Hani J, Pandit Anand S
UCL Queen Square Institute of Neurology, London, United Kingdom.
UCL Medical School, London, United Kingdom.
Ann Surg. 2025 Apr 21. doi: 10.1097/SLA.0000000000006736.
This systematic review aimed to identify cognitive biases and heuristics experienced by surgeons in operative settings and the impact these biases and heuristics have on patient care.
Cognitive biases and heuristics are systematic errors in thinking that can affect clinical decisions. Both are noted in surgical settings and are a risk to patient safety.
This review was conducted in accordance with PRISMA guidelines and PROSPERO registered (CRD42023432099). Five major databases were searched from inception to 28th August 2022, with an updated search on 27th January 2024. Original primary research studies in English were included, with relevant risk of bias tools employed for each study.
21 papers were included. 38 biases were identified across six experiments, five analyses, and ten survey studies. Confirmation bias, anchoring, risk aversion, and overconfidence bias were the most represented. Risk of bias was moderate across most studies. Cognitive biases and heuristics were found to influence surgical outcomes and six studies cited a negative impact on patient care, with one associating biases with fatal outcomes.
Biases and heuristics contribute to surgical errors and never events, and will continue to do so until they are recognised and addressed. Implementing debiasing strategies, such as mindfulness training and deliberate reflection, was found to reduce surgical errors in two studies. This review highlights the need for experimental studies, which are essential for understanding how and why biases lead to negative outcomes and for evaluating further debiasing interventions. We propose directions for future research and system changes.
本系统评价旨在识别外科医生在手术过程中经历的认知偏差和启发式思维，以及这些偏差和启发式思维对患者护理的影响。
认知偏差和启发式思维是思维中的系统性错误，会影响临床决策。两者在手术环境中均有体现，对患者安全构成风险。
本评价按照PRISMA指南进行，并在PROSPERO注册（CRD42023432099）。检索了五个主要数据库，从建库至2022年8月28日，并于2024年1月27日进行了更新检索。纳入了英文的原始初级研究，每项研究都使用了相关的偏倚风险工具。
纳入21篇论文。在六个实验、五项分析和十项调查研究中识别出38种偏差。确认偏差、锚定、风险规避和过度自信偏差最为常见。大多数研究的偏倚风险为中等。发现认知偏差和启发式思维会影响手术结果，六项研究指出对患者护理有负面影响，其中一项将偏差与致命结果相关联。
偏差和启发式思维会导致手术失误和不良事件，并且在未被认识和解决之前将继续如此。在两项研究中发现，实施去偏策略，如正念训练和深思熟虑的反思，可减少手术失误。本评价强调了实验研究的必要性，这对于理解偏差如何以及为何导致负面结果以及评估进一步的去偏干预措施至关重要。我们提出了未来研究和系统变革的方向。
