The following is a summary of “Equipoise Ruler: A National Survey on Surgeon Judgment About the Value of Surgery,” published in the December 2024 issue of Surgery by Zychowski et al.
Professional norms may improve surgical decision-making, but the extent to which these norms exist among surgeons in the United States is not well understood.
Researchers conducted a prospective study to understand surgeons’ judgment regarding the value of surgery.
They administered a survey with 30 cases asking surgeons to rate the likelihood of performing surgery on a scale from “definitely would do this surgery” to “definitely would not do this surgery.” Surgeons repeated the assessments after seeing peer responses. In-depth interviews helped clarify their rationale.
The results showed 580 surgeons responded (28.5% response rate), and for or 19 of 30 cases, consensus (≥60% agreement) existed on the value of surgery (range: 63% to 99%). Consensus increased after exposure to peer responses, female surgeons were more likely to recommend nonoperative treatment for high-risk cases, while surgical specialists were less likely to perform salvage surgeries. Surgeons often deferred decisions to people, allowing them to make the final call despite their own assessments.
They concluded that professional judgment on the value of surgery exists along a continuum but can be improved by exposure to peer assessments.
