Healy JM, et al. - In this study, internal medicine and general surgery trainees were compared with respect to their assessment of the risk of surgically complex patients. Both groups of residents showed similar estimates of postoperative complications and death and, overestimated risks in surgically complex patient scenarios compared with National Surgical Quality Improvement Project (NSQIP) risk calculator estimates. Notably, the importance of developing risk-estimation resources for internists and surgeons was emphasized by this near-universal overestimation of risk.

Methods

• In this study, an anonymous, online assessment of 7 real-life, complex clinical scenarios was answered by general surgery and internal medicine residents (urban, tertiary, and academic medical center).
• They were asked to estimate the chance of any morbidity, mortality, surgical site infection, pneumonia, and cardiac complications.
• Scenarios represented a diverse general surgery practice, including colectomy, duodenal ulcer repair, inguinal hernia repair, perforated viscus exploration, small-bowel resection, cholecystectomy, and mastectomy in surgically complex patients likely to be comanaged by surgical and internal medicine services.
• Thereafter, responses were compared with risk-adjusted outcomes reported by the American College of Surgeons’ National Surgical Quality Improvement Project (NSQIP) online calculator.

Results

• The participants included a total of 76 general surgery residents (50 [65.8%] male and 26 [34.2%] female) and 76 internal medicine residents (36 [47.4%] male and 40 [52.6%] female) (64% overall response rate).
• Findings demonstrated that general surgery residents were significantly more confident with their responses (general surgery residents’ mean response, 3.6 [95% CI, 3.4-2.8]; internal medicine residents’ mean response, 2.8 [95% CI, 2.6-3.0]; P < .001) and with not offering operations (general surgery residents’ mean response, 4.3 [95% CI, 4.1-4.4]; internal medicine residents’ mean response, 3.7 [95% CI, 3.4-3.9]; P = .006) but less likely to discuss code status (general surgery residents’ mean response, 3.2 [95% CI, 2.9-3.4]; internal medicine residents’ mean response, 3.8 [95% CI, 3.5-4.1]; P < .001) or consult risk-adjusted models, such as NSQIP (general surgery residents’ mean response, 2.9 [95% CI, 2.7-3.1]; internal medicine residents’ mean response, 3.7 [95% CI, 3.4-4.0]; P < .001).
• It was also evident that for 91% of clinical estimates, both groups similarly overestimated every type of risk; in 9% of estimates, internal medicine residents had higher overestimates.
• Data showed that estimates varied significantly, with wide 95% CIs; however, only 11% of the NSQIP estimates fell within the 95% CIs.
• Overall, researchers noted that the mean percentages of the estimates ranged from 26% to 33% over NSQIP estimates for all complications.