Abstract
BackgroundCognitive errors have a considerable effect on procedural outcome. They play a major role in situational judgement and decision making, especially during cognitively demanding tasks. As such they need to be considered an important factor in medical and surgical procedures. However, whereas cognitive diagnostic errors are well known, as of yet the occurrence of errors due to cognitive heuristics may have been downplayed, underestimated, or simply been ignored during the course of surgical treatment.MethodsAll colorectal resections with anastomosis in 2015 and 2016 (n = 230) were prospectively screened for anastomotic failure (n = 17/230). During structured Morbidity and Mortality Conferences (MMC) all anastomotic failures were analyzed for both tactical and technical decisions in the pre- and intraoperative setting with potential meaning for the postoperative course, based on the London Protocol. In order to demonstrate the significance of cognitive errors in surgical procedures a structured interview with the individual surgeon was conducted including the video and photo documentation of the individual surgical procedure. The interviews were coded by independent coders who were instructed to identify defined cognitive errors. Inter-coder agreement was calculated using Krippendorff’s alpha.ResultsIn 12/17 patients with anastomotic failure after colorectal surgery tactical or technical decisions with potential negative influence on anastomotic healing or the postoperative course were assessed during MMC. In 8/12 procedures a structured interview could be conducted with the operating surgeon. In 7/8 procedures cognitive errors could be identified. In particular we found Anchoring (n = 1), Availability Bias (n = 1), Commission Bias (n = 1), Overconfidence Bias (n = 1), Omission Bias (n = 2) and Sunk Costs (n = 1).ConclusionCognitive errors seem to play an important role during surgical therapy of patients with anastomotic failure after colorectal resection. Consequently, we suggest cognitive errors should attract more interest in research as well as attention in clinical practice.
Highlights
Cognitive errors have a considerable effect on procedural outcome
In order to investigate the occurrence of cognitive errors during the therapy of patients with anastomotic leak in colorectal surgery, we screened colorectal resections performed during the years 2015 and 2016 for complications
In 12/17 patients with anastomotic leak noticeable problems could be identified during Morbidity and Mortality Conferences (MMC) regarding the basic requirements for uneventful healing of anastomoses or treatment procedure of anastomotic leaks
Summary
Cognitive errors have a considerable effect on procedural outcome. They play a major role in situational judgement and decision making, especially during cognitively demanding tasks. As such they need to be considered an important factor in medical and surgical procedures. Concerning anastomotic leak, most patients’ inherent risk factors are the primary focus of medical error analysis [2]. In the case of patient-independent factors, noticeable problems in operating technique and strategy, as well as irregularities during processes and structure are to be considered. Where structural quality is more environment-related, noticeable problems in diagnostics, operating technique and strategy, as well as procedural adherence are more individual-related
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