Document Detail


A reader's guide to surgical decision analysis.
MedLine Citation:
PMID:  9179115     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Studies using decision analysis appear increasingly often in the surgical literature. Because readers and reviewers may be unfamiliar with decision analysis, we review the technique and provide guidance on its interpretation. STUDY DESIGN: Review article. RESULTS: Decision analysis is a systematic approach to structuring a decision, collecting relevant information about the probability and relative value of outcomes, and making quantitative recommendations. Decision analysis includes the following basic components: (1) the decision model, (2) the probabilities of clinical outcomes in the model, (3) the utilities of clinical outcomes, and (4) the analysis and interpretation. To critically interpret the results of a decision analysis, readers must consider the validity of each component. The model should include all relevant clinical strategies and all important clinical outcomes. Probability estimates, whether derived from published studies or based on "clinical consensus," should be in general agreement with the reader's clinical experience. Utilities (values assigned to outcomes) are often expressed in terms of quality-adjusted life expectancy. Methods used to estimate life expectancy and to adjust for quality of life must be scrutinized carefully. Within the analysis, readers should consider the effect of varying uncertain variables in the model (sensitivity analysis) and, thus, the stability of the results. Finally, readers must assess whether the magnitude of expected benefit from the favored clinical strategy is clinically important. CONCLUSIONS: As decision analysis becomes more frequently used to influence clinical policy in surgery, surgeons must learn to examine the technique more critically.
Authors:
J D Birkmeyer; H G Welch
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Publication Detail:
Type:  Journal Article; Research Support, U.S. Gov't, Non-P.H.S.; Review    
Journal Detail:
Title:  Journal of the American College of Surgeons     Volume:  184     ISSN:  1072-7515     ISO Abbreviation:  J. Am. Coll. Surg.     Publication Date:  1997 Jun 
Date Detail:
Created Date:  1997-07-15     Completed Date:  1997-07-15     Revised Date:  2008-11-21    
Medline Journal Info:
Nlm Unique ID:  9431305     Medline TA:  J Am Coll Surg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  589-95     Citation Subset:  AIM; IM    
Affiliation:
Department of Veterans Affairs Medical Center, White River Junction, Vt 05001, USA.
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MeSH Terms
Descriptor/Qualifier:
Decision Support Techniques*
General Surgery*
Humans
Markov Chains
Models, Theoretical
Quality-Adjusted Life Years

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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