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Effect of Specialty and Recent Experience on Perioperative Decision‐Making for Abdominal Aortic Aneurysm Repair
Author(s) -
Dale William,
Hemmerich Joshua,
Moliski Elizabeth,
Schwarze Margaret L.,
Tung Avery
Publication year - 2012
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/j.1532-5415.2012.04157.x
Subject(s) - medicine , perioperative , specialty , guideline , abdominal aortic aneurysm , vascular surgery , american society of anesthesiologists , watchful waiting , geriatrics , general surgery , abdominal surgery , emergency medicine , intensive care medicine , surgery , aneurysm , family medicine , cardiac surgery , pathology , prostate cancer , cancer , psychiatry
Objectives To determine whether recent experience and specialty choice would affect physician adherence to evidence‐based guidelines. Design In a series of computer‐simulated encounters, participants weighed the risk of spontaneous abdominal aortic aneurysm ( AAA ) rupture against the risk of perioperative death to determine timing for elective repair. Guideline recommendations and statistical information on the risks of rupture and surgical death were provided. Setting Annual meetings of the A merican G eriatrics S ociety, A merican C ollege of S urgeons, and A merican S ociety of A nesthesiologists. Participants Physicians. Intervention Before the simulation, each participant was randomly exposed to one of three simulated outcomes: death during watchful waiting ( WWD ), perioperative death ( PD ), or successful outcome ( SO ). Measurements Adherence to recommended guidelines for AAA treatment. Results Against guideline recommendations, 67% of geriatricians, 74% of anesthesiologists, and 77% of surgeons chose surgery when the rupture risk was lower than the risk of perioperative death ( P < .05). Surgeons exposed to the WWD experience chose surgery significantly earlier than if they were exposed to a PD or SO experience ( P < .001). Anesthesiologist choices did not differ with recent experience. Conclusion Geriatrician decisions more closely followed guideline recommendations for AAA management than those of two other specialties typically involved in AAA care. A prior WWD affected surgeons most, geriatricians next, and anesthesiologists least. Geriatricians referring patients for AAA surgery should be aware of specialty‐specific differences in perioperative decision behavior.