ANALYSIS OF THE VARIETY IN SURGEONS DECISION STRATEGIES FOR THE MANAGEMENT OF LEFT COLONIC EMERGENCIES

OBJECTIVES. The aim of this study is to analyze surgeons' decision str ategies about the optimal treatment for acute sigmoid resection for di fferent patients. In particular, the authors wished to determine the p redominant accepted treatment choice among surgeons, to determine the importance of patient characteristics for surgeons' evaluations of the appropriateness of treatments, and to identify the variety in decisio n strategies. METHODS, A survey was carried out among all surgical mem bers of the Netherlands Society of Gastro Intestinal Surgery, who eval uated 16 patient cases. Approximately 70% of the members completed the survey. RESULTS. Overall, the predominant accepted strategy is resect ion, delayed anastomosis, and colostomy (Hartmann procedure). Consensu s in terms of preferred treatment, however, was low. The most importan t factors influencing surgeons' evaluations of the appropriateness of treatments were the age of a patient, the degree of peritonitis, and t he degree of fecal contamination. Further analysis showed that the var iety in surgeons' decision strategies could not be explained by differ ences in experience, but was shown to be related to the evaluation of the appropriateness of treatment for 60-year-old patients and patients with a local peritonitis. Except for these factors, surgeons did not differ fundamentally in the evaluation of the factors that make a trea tment more appropriate. Surgeons agreed about the optimal treatment fo r older patients in poor condition, although there is no epidemiologic literature to support this consensus position. CONCLUSIONs. This stud y showed that lack of consensus in surgeons' choice of treatment could be explained partly by disagreement of the appropriateness of treatme nts for some, rather than all, patients.