Purpose
The purpose of this study was to evaluate factors that influence surgeons’ decision-making
in the treatment of distal radius fractures in older patients.
Methods
Fourteen clinical vignettes of a 72-year-old patient with a distal radius fracture
were sent to 185 orthopedic hand and/or trauma surgeons. The surgeons were surveyed
regarding the demographic/practice details, treatment decision (surgical or nonsurgical),
and factors that influenced management, including the Charlson Comorbidity Index,
functional status, radiographic appearance, and handedness. Multivariable regression
analyses were used to assess the effect of both surgeon-described (explicit) and given
clinical (implicit) factors on the treatment decision and to evaluate for discrepancies.
Results
Sixty-six surgeons completed the survey, and 7 surgeons completed 10–13 vignettes.
Surgeons made the explicit determination to pursue nonsurgical treatment based on
the presence of comorbidities (odds ratio [OR], 0.02 for surgery; 95% confidence interval
[CI], 0.01–0.05), but the observation of the underlying clinical data suggested that
the recommendation for surgical treatment was instead based on a higher functional
status (OR, 3.54/increase in functional status; 95% CI, 2.52–4.98). Those employed
by hospitals/health systems were significantly less likely to recommend surgery than
those in private practice (OR, 0.42; 95% CI, 0.23–0.79)
Conclusions
This study demonstrates that the presence of comorbidities, functional status, and
practice setting has a significant impact on a surgeon’s decision to treat distal
radius fractures in older patients. The discrepancy between the surgeon-described
factors and underlying clinical data demonstrates cognitive bias.
Clinical relevance
Surgeons should be aware of cognitive biases in clinical reasoning and should work
through consequential patient decisions using an analytical framework that attempts
to reconcile all available clinical data.
Key words
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Article info
Publication history
Published online: June 02, 2022
Accepted:
March 23,
2022
Received:
March 17,
2021
Footnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
Copyright
© 2022 by the American Society for Surgery of the Hand. All rights reserved.
