374 Cognitive Biases and Heuristics in Surgical Settings: A Systematic Review

Abstract

Abstract Aim Cognitive biases and heuristics represent mental shortcuts that can lead to errors in judgement. Both are noted in surgical settings and risk patient safety. Yet, up till now, the extent of biases in surgical settings has not been systematically reviewed. Method This PROSPERO registered (CRD42022334828) review was conducted in accordance with PRISMA guidelines. MEDLINE and four other major databases were searched from their inception to 28th August 2022 using “surg*” with “cognitive bia*” and “heuristics” terms. Original primary research studies in English were included, with blinded full text screening. Relevant risk of bias (RoB) tools were employed for each study. Results The search identified 26,640 papers. Following de-duplication and screening, 16 final papers were included. 34 biases were identified including three prospective experiments, three retrospective analyses, and 10 questionnaire studies. Confirmation and anchoring biases were the most represented. RoB analysis found broad heterogeneity, with four studies being deemed of high risk. All identified cognitive biases were found to influence relevant surgical outcomes and seven studies cited a negative impact on patient care. Conclusions Cognitive biases will continue to contribute to surgical errors and never events unless they are described and recognised with greater precision and de-biasing strategies are implemented. Of note, mindfulness-based training and deliberate reflection tested by two studies demonstrated reduced rates of surgical error. Nevertheless, our review demonstrates a lack of experimental studies which are crucial to understanding why and how biases contribute to negative outcomes and we suggest avenues for further research and systems change.