Article Figures & Data
- Figure 1
Adjusted rates of participants selecting they would be ‘likely’ or ‘very likely’ to offer an operation to the patient in each case, by surgeon specialty. ACS, acute care surgeon; SO, surgical oncologist.
- Table 1
Characteristics of the surgeon respondents and their current practices, reported as n (%)
Variable Category All participants n (%) Acute care surgeons (n=197) Surgical oncologists (n=119) P value Age, years (median, IQR) 45 (39–53) 43 (38–52) 48 (42–57) <0.01 Gender Female 78 (24.7) 54 (27.4) 24 (20.2) 0.25 Male 237 (75.0) 142 (72.1) 95 (79.8) Other 1 (0.3) 1 (0.5) 0 Fellowship training None 26 (8.2) 22 (11.2) 4 (3.4) <0.01 Surgical oncology 107 (33.9) 3 (1.5) 104 (87.4) Trauma/acute care 171 (54.1) 170 (86.3) 1 (0.8) Other 12 (3.8) 2 (1.0) 10 (8.4) Current practice Surgical oncology 97 (30.7) – 97 (81.5) – Trauma and/or acute care 197 (62.3) 197 (100) – Peritoneal surface malignancy 22 (7.0) – 22 (18.5) Years in practice <5 83 (26.3) 64 (32.5) 19 (16.0) <0.01 5–10 79 (25.0) 52 (26,4) 27 (22.7) 11–15 42 (13.3) 19 (9.6) 23 (19.3) 16–20 40 (12.7) 24 (12.2) 16 (13.5) 21–25 32 (10.1) 18 (9.1) 14 (11.8) >25 40 (12.7) 20 (10.2) 20 (16.8) Type of practice Academic 187 (59.2) 102 (51.8) 85 (71.4) <0.01 Private 50 (15.8) 37 (18.8) 13 (10.9) Both private and academic 64 (20.3) 47 (23.9) 17 (14.3) Other 15 (4.8) 11 (5.6) 4 (3.4) Location Northeast 71 (22.5) 37 (18.8) 34 (28.6) 0.07 Southeast 85 (26.9) 48 (24.4) 37 (31.1) Midwest 80 (25.3) 56 (28.4) 24 (20.2) Southern 24 (7.6) 15 (7.6) 9 (7.6) Mountain West 25 (7.9) 20 (10.2) 5 (4.2) Pacific 31 (9.8) 21 (10.7) 10 (8.4) Rurality Urban 188 (59.5) 113 (57.4) 75 (63.0) 0.28 Suburban 89 (28.2) 57 (28.9) 32 (26.9) Rural 32 (10.1) 24 (12.2) 8 (6.7) Other 7 (2.2) 3 (1.5) 4 (3.4) - Table 2
Univariable analysis of factors predictive of participants selecting they would be ‘likely’ or ‘very likely’ to offer an operation to the patient in each case
Case 1 (n=316) Case 2 (n=290) Case 3 (n=273) Likely P value Likely P value Likely P value Gender Female 57 (73.1) 0.324 29 (41.4) 0.525 28 (42.4) 0.351 Male 191 (80.6) 95 (43.4) 102 (49.5) Fellowship training Surgical oncology 94 (87.9) 0.002 52 (51.5) 0.022 61 (61.0) 0.002 Trauma/acute care 124 (72.5) 57 (37.0) 57 (40.4) Current practice Surgical oncology 103 (86.6) 0.009 57 (50.9) 0.034 66 (59.5) 0.002 Trauma/acute care 146 (74.1) 68 (38.2) 65 (40.1) Years in practice <5 61 (73.5) 0.068 20 (28.6) 0.040 25 (38.5) 0.228 5–10 58 (73.4) 30 (40.0) 34 (47.2) 11–15 32 (76.2) 21 (55.3) 19 (54.3) 16–20 34 (85.0) 18 (46.2) 17 (44.7) 21–25 26 (81.3) 15 (50.0) 14 (48.3) >25 38 (95.0) 21 (55.3) 22 (64.7) Type of practice Academic 151 (80.8) 0.458 76 (44.2) 0.924 79 (47.9) 0.775 Private 38 (76.0) 20 (40.8) 20 (45.5) Location Northeast 61 (85.9) 0.051 34 (54.0) 0.094 30 (51.7) 0.416 Southeast 70 (82.4) 34 (44.2) 36 (49.3) Midwest 64 (80.0) 35 (46.7) 37 (52.8) Southern 14 (58.3) 7 (31.8) 7 (33.3) Mountain West 17 (68.0) 6 (26.1) 11 (50.0) Pacific 23 (74.2) 9 (30.0) 10 (34.5) Rurality Urban 144 (76.6) 0.461 68 (38.9) 0.103 78 (47.6) 0.478 Suburban 74 (83.2) 39 (48.8) 36 (46.8) Rural 25 (78.1) 16 (57.1) 15 (60.0) Individual cases were analyzed separately. Participant selections were averaged across all scenarios within each case.
- Table 3
Univariable and multivariable analysis of factors predictive of participants selecting they would be ‘likely’ or ‘very likely’ to offer an operation to the patient in each case; participant selections were averaged across all scenarios across all cases
Univariable Multivariable* n (%) P value Incidence rate ratio (95% CI) P value Gender Female 30 (45.5) 0.241 Male 114 (55.3) Fellowship training Surgical oncology 73 (73.0) <0.001 Excluded† Trauma/acute care 55 (39.0) Current practice Surgical oncology 78 (70.3) <0.001 Reference – Trauma/acute care 67 (41.4) 0.61 (0.49 to 0.76) <0.001 Years in practice <5 27 (41.5) 0.001 0.66 (0.47 to 0.91) 0.011 5–10 32 (44.4) 0.65 (0.48 to 0.89) 0.008 11–15 25 (71.4) 0.90 (0.68 to 1.19) 0.462 16–20 17 (44.7) 0.61 (0.42 to 0.88) 0.009 21–25 17 (58.6) 0.78 (0.56 to 1.09) 0.150 >25 27 (79.4) Reference – Type of practice Academic 87 (52.7) 0.452 Private 26 (59.1) Location Northeast 38 (65.5) 0.101 Reference – Southeast 39 (53.4) 0.93 (0.70 to 1.22) 0.586 Midwest 39 (55.7) 1.02 (0.79 to 1.32) 0.880 Southern 7 (33.3) 0.59 (0.32 to 1.08) 0.087 Mountain West 10 (45.5) 1.06 (0.66 to 1.71) 0.818 Pacific 12 (41.4) 0.79 (0.51 to 1.23) 0.301 Rurality Urban 77 (47.0) 0.017 Reference – Suburban 49 (63.6) 1.34 (1.06 to 1.70) 0.014 Rural 17 (68.0) 1.56 (1.14 to 2.13) 0.006 *All variables with p<0.20 on univariable analysis included in multivariable analysis.
†Fellowship training excluded from multivariable analysis as this variable is confounding with the variable describing current practice.
- Table 4
Responses to individual case scenarios by practice type
Total Surgical oncologists Acute care surgeons P value Case 1: a 50-year-old man with colon cancer 36 months from resection and adjuvant chemotherapy with a single point of obstruction in the terminal ileum. He has a single, 3 cm metastatic lesion in his liver, but no other metastatic disease. Base scenario 94.94 (4.70±0.64) 95.80 (4.83±0.48) 94.42 (4.62±0.71) 0.587 Multiple hepatic metastases 82.91 (4.16±0.97) 91.60 (4.48±0.72) 77.66 (3.97±1.04) 0.001 Pulmonary metastases 71.84 (3.87±1.16) 84.87 (4.31±0.83) 63.96 (3.60±1.24) <0.001 Shorter disease-free interval 86.08 (4.29±0.84) 87.39 (4.39±0.78) 85.28 (4.23±0.87) 0.599 Omental metastases 63.92 (3.68±1.11) 78.15 (4.05±0.95) 55.33 (3.46±1.15) <0.001 Pancreatic adenocarcinoma 46.84 (3.22±1.24) 47.06 (3.24±1.22) 46.70 (3.22±1.26) 0.951 Case 2: a 45-year-old woman with epithelial ovarian cancer 36 months from optimal debulking and adjuvant chemotherapy with a single point of obstruction in the small bowel from carcinomatosis. She has three peritoneal implants, but no other metastatic disease. Base scenario 74.48 (3.97±1.12) 90.18 (4.29±0.86) 64.61 (3.60±1.19) <0.001 Ascites present 57.24 (3.41±1.19) 74.11 (3.81±1.04) 46.63 (3.16±1.21) <0.001 Multiple areas of obstruction 22.76 (2.54±1.17) 26.79 (2.65±1.13) 20.22 (2.48±1.18) 0.194 2nd episode of obstruction 24.48 (2.63±1.14) 25.00 (2.63±1.07) 24.16 (2.65±1.18) 0.871 Shorter disease-free interval 47.59 (3.24±1.13) 50.00 (3.29±1.03) 46.07 (3.22±1.18) 0.514 Melanoma 73.10 (3.88±1.15) 87.50 (4.27±0.99) 64.04 (3.63±1.19) <0.001 Case 3: a 62-year-old woman with a carcinoid tumor 48 months from resection of an isolated mesenteric mass with a single point of obstruction in the jejunum from an unresectable central mesenteric mass. Base scenario 83.88 (4.21±0.93) 90.99 (4.50±0.74) 79.01 (4.01±0.99) 0.008 Stable hepatic metastases 75.09 (3.94±1.00) 87.39 (4.33±0.81) 66.67 (3.67±1.03) <0.001 2nd episode of obstruction 44.69 (3.22±1.11) 54.95 (3.41±1.03) 37.65 (3.08±1.15) 0.005 Shorter disease-free interval 32.97 (2.82±1.23) 36.94 (2.91±1.25) 30.25 (2.76±1.21) 0.248 Multiple areas of obstruction 32.60 (2.90±1.15) 39.64 (3.09±1.12) 27.78 (2.78±1.15) 0.04 All patients were described as being otherwise healthy with good functional status. Patients had no signs of peritonitis or other indications for emergent surgery, although participants were informed that the obstruction would not resolve with conservative management. Responses reported as percent responding ‘likely’ or ‘very likely’ to offer an operation (mean response on the 5-point Likert scale±SD). Full case scenarios are shown in online supplemental file 1.
Supplementary Materials
Supplementary data
Additional Files
Supplementary Data
This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.
