From the Guidelines
Surgical procedures are inherently subjective due to the variability in patient anatomy, the need for adaptable decision-making during surgery, and the role of surgeon judgment and experience. The technical aspects of surgery, such as anatomical landmarks and measurable outcomes, provide an objective foundation, but the application of these principles is highly dependent on the surgeon's expertise and interpretation 1.
Key Considerations
- The effectiveness of surgical procedures can vary significantly depending on the individual patient and the specific circumstances of the case 1.
- High-level evidence is often lacking for many surgical procedures, making it difficult to determine their objective effectiveness 1.
- The decision to undergo surgery should be based on a careful consideration of the potential benefits and risks, as well as the availability of alternative treatments 1.
Evidence-Based Practice
The study published in the BMJ in 2021 highlights the importance of seeking high-level evidence to support surgical decisions 1. It also notes that some surgical procedures may be effective only in specific circumstances or for certain types of patients. For example, arthroscopic partial meniscectomy may be recommended for patients with a specific type of meniscal tear who have not responded to non-surgical treatment 1.
Clinical Implications
In clinical practice, surgeons must balance the objective aspects of surgery with the subjective elements of patient care. This includes considering the individual patient's needs, preferences, and values, as well as their unique anatomical and physiological characteristics 1. By acknowledging the subjective nature of surgical decision-making, clinicians can provide more personalized and effective care for their patients.
From the Research
Surgical Procedures: Objective or Subjective
Surgical procedures can be both objective and subjective, depending on the context and criteria used to evaluate them.
- Objective measures of surgical procedures are typically based on quantifiable data, such as mortality rates, complication rates, and operative times 2.
- Subjective measures, on the other hand, rely on the surgeon's clinical judgment and personal experience, which can vary from one individual to another 2, 3.
Regulation of Surgical Procedures
The regulation of surgical procedures is largely indirect, with no federal agency responsible for approving or regulating new surgical procedures 4.
- This lack of regulation can lead to variability in surgical techniques and outcomes, making it difficult to compare and evaluate different procedures 4.
- Some studies have called for increased regulation of surgical procedures to improve patient safety and ensure that surgeons are using evidence-based practices 4, 5.
Evaluation of Surgical Skills
The evaluation of surgical skills is an important aspect of ensuring patient safety and improving surgical outcomes.
- Traditional methods of evaluating surgical skills are often subjective and based on personal opinion, which can be unreliable and biased 5, 6.
- More objective methods of evaluation, such as structured checklists and rating scales, surgical simulators, and instrument motion analysis, are being developed to provide a more accurate assessment of surgical skills 5.
- A framework for defining and measuring intraoperative performance has been proposed, which includes five domains of intraoperative performance: psychomotor skills, declarative knowledge, advanced cognitive skills, interpersonal skills, and personal resourcefulness 6.