TY - JOUR
T1 - Surgeons’ risk perception in ASD surgery
T2 - The value of objective risk assessment on decision making and patient counselling
AU - European Spine Study Group, International Spine Study Group
AU - Pellisé, Ferran
AU - Vila-Casademunt, Alba
AU - Núñez-Pereira, Susana
AU - Haddad, Sleiman
AU - Smith, Justin S.
AU - Kelly, Michael P.
AU - Alanay, Ahmet
AU - Shaffrey, Christopher
AU - Pizones, Javier
AU - Yilgor, Çaglar
AU - Obeid, Ibrahim
AU - Burton, Douglas
AU - Kleinstück, Frank
AU - Fekete, Tamas
AU - Bess, Shay
AU - Gupta, Munish
AU - Loibl, Markus
AU - Klineberg, Eric O.
AU - Sánchez Pérez-Grueso, Francisco J.
AU - Serra-Burriel, Miquel
AU - Ames, Christopher P.
N1 - Publisher Copyright:
© 2022, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
PY - 2022/5
Y1 - 2022/5
N2 - Background: Surgeons often rely on their intuition, experience and published data for surgical decision making and informed consent. Literature provides average values that do not allow for individualized assessments. Accurate validated machine learning (ML) risk calculators for adult spinal deformity (ASD) patients, based on 10 year multicentric prospective data, are currently available. The objective of this study is to assess surgeon ASD risk perception and compare it to validated risk calculator estimates. Methods: Nine ASD complete (demographics, HRQL, radiology, surgical plan) preoperative cases were distributed online to 100 surgeons from 22 countries. Surgeons were asked to determine the risk of major complications and reoperations at 72 h, 90 d and 2 years postop, using a 0–100% risk scale. The same preoperative parameters circulated to surgeons were used to obtain ML risk calculator estimates. Concordance between surgeons’ responses was analyzed using intraclass correlation coefficients (ICC) (poor < 0.5/excellent > 0.85). Distance between surgeons’ and risk calculator predictions was assessed using the mean index of agreement (MIA) (poor < 0.5/excellent > 0.85). Results: Thirty-nine surgeons (74.4% with > 10 years’ experience), from 12 countries answered the survey. Surgeons’ risk perception concordance was very low and heterogeneous. ICC ranged from 0.104 (reintervention risk at 72 h) to 0.316 (reintervention risk at 2 years). Distance between calculator and surgeon prediction was very large. MIA ranged from 0.122 to 0.416. Surgeons tended to overestimate the risk of major complications and reintervention in the first 72 h and underestimated the same risks at 2 years postop. Conclusions: This study shows that expert surgeon ASD risk perception is heterogeneous and highly discordant. Available validated ML ASD risk calculators can enable surgeons to provide more accurate and objective prognosis to adjust patient expectations, in real time, at the point of care.
AB - Background: Surgeons often rely on their intuition, experience and published data for surgical decision making and informed consent. Literature provides average values that do not allow for individualized assessments. Accurate validated machine learning (ML) risk calculators for adult spinal deformity (ASD) patients, based on 10 year multicentric prospective data, are currently available. The objective of this study is to assess surgeon ASD risk perception and compare it to validated risk calculator estimates. Methods: Nine ASD complete (demographics, HRQL, radiology, surgical plan) preoperative cases were distributed online to 100 surgeons from 22 countries. Surgeons were asked to determine the risk of major complications and reoperations at 72 h, 90 d and 2 years postop, using a 0–100% risk scale. The same preoperative parameters circulated to surgeons were used to obtain ML risk calculator estimates. Concordance between surgeons’ responses was analyzed using intraclass correlation coefficients (ICC) (poor < 0.5/excellent > 0.85). Distance between surgeons’ and risk calculator predictions was assessed using the mean index of agreement (MIA) (poor < 0.5/excellent > 0.85). Results: Thirty-nine surgeons (74.4% with > 10 years’ experience), from 12 countries answered the survey. Surgeons’ risk perception concordance was very low and heterogeneous. ICC ranged from 0.104 (reintervention risk at 72 h) to 0.316 (reintervention risk at 2 years). Distance between calculator and surgeon prediction was very large. MIA ranged from 0.122 to 0.416. Surgeons tended to overestimate the risk of major complications and reintervention in the first 72 h and underestimated the same risks at 2 years postop. Conclusions: This study shows that expert surgeon ASD risk perception is heterogeneous and highly discordant. Available validated ML ASD risk calculators can enable surgeons to provide more accurate and objective prognosis to adjust patient expectations, in real time, at the point of care.
KW - Adult spinal deformity
KW - Computerized decision support tools
KW - Machine learning
KW - Risk perception
KW - Surgery
UR - http://www.scopus.com/inward/record.url?scp=85130765722&partnerID=8YFLogxK
U2 - 10.1007/s00586-022-07166-2
DO - 10.1007/s00586-022-07166-2
M3 - Article
C2 - 35347422
AN - SCOPUS:85130765722
SN - 0940-6719
VL - 31
SP - 1174
EP - 1183
JO - European Spine Journal
JF - European Spine Journal
IS - 5
ER -