Rosen Claire B, Bader Amanda L, Roberts Sanford E, Clapp Justin T, Halpern Scott D, Schwarze Margaret L, Kelz Rachel R
From the Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA.
Department of Anesthesiology & Critical Care, Hospital of the University of Pennsylvania; Philadelphia, PA.
Ann Surg Open. 2025 Apr 21;6(2):e567. doi: 10.1097/AS9.0000000000000567. eCollection 2025 Jun.
To understand how surgeons perceive risk calculators in emergency general surgery (EGS).
EGS involves complex decision-making of operative and nonoperative management. Risk calculators can aid in shared decision-making and informed consent.
We performed semi-structured interviews among emergency surgeons within 1 healthcare system to explore perceptions of risk calculators in EGS. Interviews were completed until thematic saturation, transcribed, coded in duplicate, and analyzed using inductive analysis within a modified grounded theory framework to generate theory regarding surgeon perceptions of risk calculators in EGS.
Among 20 interviewees, the mean age was 45. We identified dominant themes related to the concerns of and benefits of using risk calculators within EGS, both in situations of clear and unclear best treatment options. Surgeons questioned risk calculator validity and noted that a lack of health numeracy can limit their use. Risk calculators were seen as helpful for communication, consensus building, informed consent, and litigation mitigation. The ideal risk calculator should have low activation energy for use, incorporate relevant data and accurate prognostication, and provide actionable, easily interpretable output. Education for providers and patients on risk calculator availability and use is necessary.
Although surgeons may initially question the data produced by risk calculators in EGS, they identify several potential virtues to their bedside use when optimal treatment options are and are not clear. The ideal risk calculator for use in EGS should be convenient and relevant. Future studies are needed to explore patient perceptions and to directly observe patterns of risk calculator use.
了解外科医生如何看待急诊普通外科（EGS）中的风险计算器。
EGS涉及手术和非手术管理的复杂决策。风险计算器有助于共同决策和知情同意。
我们在一个医疗系统内对急诊外科医生进行了半结构化访谈，以探讨他们对EGS中风险计算器的看法。访谈持续进行直至主题饱和，进行转录、双人编码，并在改良的扎根理论框架内使用归纳分析进行分析，以生成关于外科医生对EGS中风险计算器看法的理论。
在20名受访者中，平均年龄为45岁。我们确定了与在EGS中使用风险计算器的担忧和益处相关的主要主题，涵盖最佳治疗方案明确和不明确的情况。外科医生质疑风险计算器的有效性，并指出缺乏健康数字素养会限制其使用。风险计算器被认为有助于沟通、建立共识、知情同意和减轻诉讼风险。理想的风险计算器应具有低使用激活能量，纳入相关数据并进行准确预后，且提供可操作、易于解释的输出。有必要对医护人员和患者进行关于风险计算器可用性和使用的教育。
尽管外科医生最初可能会质疑EGS中风险计算器产生的数据，但他们认识到在最佳治疗方案明确和不明确时，在床边使用风险计算器有几个潜在优点。用于EGS的理想风险计算器应方便且相关。未来需要开展研究以探索患者的看法，并直接观察风险计算器的使用模式。
