The impact of perceived frailty on surgeons' estimates of surgical risk.

Background: Physicians are only moderately accurate in estimating surgical risk based on clinical vignettes. We assessed the impact of perceived frailty by measuring the influence of a short video of a standardized patient on surgical risk estimates.

Methods: Thoracic surgeons and cardiothoracic trainees estimated the risk of major complications for lobectomy based on clinical vignettes of varied risk categories (low, average, high). After each vignette, subjects viewed a randomly selected video of a standardized patient exhibiting either vigorous or frail behavior, then reestimated risk. Subjects were asked to rate 5 vignettes paired with 5 different standardized patients.

Results: Seventy-one physicians participated. Initial risk estimates varied according to the vignette risk category: low 15.2%±11.2% risk; average 23.7%±16.1%; high 37.3%±18.9% (p<0.001 by analysis of variance). Concordant information in vignettes and videos moderately altered estimates (high risk vignette, frail video 10.6%±27.5% increase in estimate, p=0.006; low risk vignette, vigorous video 14.5%±45.0% decrease, p=0.009). Discordant findings influenced risk estimates more substantially (high risk vignette, vigorous video 21.2%±23.5% decrease in second risk estimate, p<0.001; low risk vignette, frail video 151.9%±209.8% increase, p<0.001).

Conclusions: Surgeons differentiated relative risk of lobectomy based on clinical vignettes. The effect of viewing videos was small when vignettes and videos were concordant; the effect was more substantial when vignettes and videos were discordant. The information will be helpful in training future surgeons in frailty recognition and risk estimation.