Complication Risks from Surgery Often Overestimated by Residents: Study

Surgical and internal medicine residents often overestimate risks and complication rates associated with surgery, according to the findings of new research. 

In a study published this week in the medical journal JAMA Surgery, researchers from the Yale School of Medicine compared information provided by residents during patient counseling about complications associated with medical procedures to a standard surgical risk calculator, raising concerns about the “near-universal” overestimations of risk.

Researchers surveyed 76 general surgery residents and 76 internal medicine residents, who are trainees practicing medicine in a limited capacity, under the supervision of an attending or advising doctor. After successfully completing a residency, doctors are allowed to practice unrestricted.

Residents who participated in the study answered anonymous online assessments of seven real-life complex surgery scenarios. They were asked to estimate the chance of morbidity, death, infections, pneumonia, and cardiac complications in various surgeries.

Surgeries included for estimates were: colectomy, duodenal ulcer repair, inguinal hernia repair, perforated viscus exploration, small-bowel resection, cholecystectomy, and mastectomy. Researchers said all were cases that are likely to be co-managed by both surgical and internal medicine services.

Overall, risk estimates of post surgical complications were not significantly different between internal residents and surgical residents. Both groups estimated the risks in similar fashions. However, both resident groups consistently overestimated the risks compared to estimates obtained using the American College of Surgeons’ National Surgical Quality Improvement Project (NSQIP) risk-adjusted model calculators.

The NSQIP is a calculator developed for doctors to help assess the potential risk of certain procedures and surgeries.

General surgery residents were often significantly more confident with their surgical risk estimates than internal medicine residents.

Yet, in 91% of the estimates of any type of surgery or any type of risk, both groups overestimated every type of risk. In about 9% of estimates, internal medicine residents overestimated the risks to a higher degree than surgical residents.

Only about 11% of the estimates given by either internal medicine residents or surgical residents matched the NSQIP risk calculations. On average, both internal medicine doctors and surgeons overestimated the risks for all complications by 26% to 33% over the NSQIP calculations.

Researchers warn that the varying range of estimates indicates a “lack of consensus” as to what the true risk of the surgery may be for complex patients. This offers different patients different ideas concerning true risk.

The findings of the study are significant because residents may overestimate the risks of surgery and postoperative risks when discussing the outcomes with patients. This may lead to some patients opting against surgery and choosing other, less effective, procedures. It may also cause more patients to seek second opinions, when not entirely necessary.

According to the researchers, the findings of the study show the need for developing universal risk-estimation resources for doctors and surgeons to use.