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Risk preferences and attitudes to surgery in decision making
Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Orthopaedics in Linköping.
Linköping University, Department of Management and Engineering, Economics. Linköping University, Faculty of Arts and Sciences. (JEDIlab)
Linköping University, Department of Management and Engineering, Economics. Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Arts and Sciences. Linköping University, Faculty of Medicine and Health Sciences. (JEDILab)ORCID iD: 0000-0002-8159-1249
Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Orthopaedics in Linköping.
2017 (English)In: Acta Orthopaedica, ISSN 1745-3674, E-ISSN 1745-3682, Vol. 88, no 5, 466-471 p.Article in journal (Refereed) Published
Abstract [en]

Background and purpose — There is increasing evidence that several commonly performed surgical procedures provide little advantage over nonoperative treatment, suggesting that doctors may sometimes be inappropriately optimistic about surgical ben- efit when suggesting treatment for individual patients. We investi- gated whether attitudes to risk influenced the choice of operative treatment and nonoperative treatment.

Methods — 946 Swedish orthopedic surgeons were invited to participate in an online survey. A radiograph of a 4-fragment proximal humeral fracture was presented together with 5 differ- ent patient characteristics, and the surgeons could choose between 3 different operative treatments and 1 nonoperative treatment. This was followed by an economic risk-preference test, and then by an instrument designed to measure 6 attitudes to surgery that are thought to be hazardous. We then investigated if choice of non-operative treatment was associated with risk aversion, and thereafter with the other variables, by regression analysis.

Results — 388 surgeons responded. Nonoperative treatment for all cases was suggested by 64 of them. There was no significant association between risk aversion and tendency to avoid surgery. However, there was a statistically significant association between suggesting to operate at least 1 of the cases and a “macho” atti- tude to surgery or resignation regarding the chances of influenc- ing the outcome of surgery. Choosing nonoperative treatment for all cases was associated with long experience as a surgeon.

Interpretation — The discrepancy between available evidence for surgery and clinical practice does not appear to be related to risk preference, but relates to hazardous attitudes. It appears that choosing nonoperative treatment requires experience and a feel- ing that one can make a difference (i.e. a low score for resigna- tion). There is a need for better awareness of available evidence for surgical indications. 

Place, publisher, year, edition, pages
Taylor & Francis Group, 2017. Vol. 88, no 5, 466-471 p.
National Category
Economics Orthopedics Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
URN: urn:nbn:se:liu:diva-137121DOI: 10.1080/17453674.2017.1298353ISI: 000407612900002OAI: oai:DiVA.org:liu-137121DiVA: diva2:1093321
Funder
Ragnar Söderbergs stiftelseMarianne and Marcus Wallenberg Foundation
Available from: 2017-05-05 Created: 2017-05-05 Last updated: 2017-08-28Bibliographically approved

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Meunier, AndreasPosadzy, KingaTinghög, GustavAspenberg, Per
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Division of Surgery, Orthopedics and OncologyFaculty of Medicine and Health SciencesDepartment of Orthopaedics in LinköpingEconomicsFaculty of Arts and SciencesDivision of Health Care Analysis
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EconomicsOrthopedicsHealth Care Service and Management, Health Policy and Services and Health Economy

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