Universität zu Köln

Vogel, P. and Vogel, D. H. V. (2019). Cognition errors in the treatment course of patients with anastomotic failure after colorectal resection. Patient Saf. Surg., 13. LONDON: BMC. ISSN 1754-9493

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Abstract

Background: 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. 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. Methods: All 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. Results: In 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). Conclusion: Cognitive 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.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Vogel, P. UNSPECIFIED UNSPECIFIED UNSPECIFIED Vogel, D. H. V. UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-158969
DOI:	10.1186/s13037-019-0184-6
Journal or Publication Title:	Patient Saf. Surg.
Volume:	13
Date:	2019
Publisher:	BMC
Place of Publication:	LONDON
ISSN:	1754-9493
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language DIAGNOSTIC ERRORS; DECISION-MAKING; HEALTH-CARE; CANCER; SAFETY; JUDGMENT; QUALITY; VOLUME; CALL Multiple languages Surgery Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/15896