The role of surgeon’s intuition for acute type A aortic dissection in an era of evidence-based medicine: a prospective cohort study

BACKGROUND: Intuition may play a role in clinical practice. This prospective cohort study aimed to explore whether surgeons’ intuition is valid in predicting the operative mortality of acute type A aortic dissection (ATAAD). METHODS: After admission (before surgery), attending surgeons were asked to rate the mortality on a scale of 1 to 10, with 1 to 3 representing unlikely, 4–6 possible, and 7–10 very likely. The area under the curve (AUC) of receiver operating characteristic (ROC) analysis was performed to assess the accuracy of prediction models. RESULTS: A significantly higher Surgeon’s Score [5.0 (2.0, 8.0) vs. 8.0 (7.0, 10.0)] was observed in the mortality group, compared to the survival group. The odds ratio (OR) for Surgeon’s Score was 1.32 [95% confidence interval (CI): 1.09–1.66, P=0.009]. Least absolute shrinkage and selection operator (LASSO) regression picked the following variables as significant predictors for early mortality of ATAAD: Surgeon’s Score, Penn classification, age, aortic regurgitation, coronary artery disease, chronic obstructive pulmonary disease, platelet count, and ejection fraction. The AUC for the German Registry for Acute Aortic Dissection Type A (GERAADA) score and Surgeon’s Score were 0.740 (95% CI: 0.625–0.854), and 0.710 (95% CI: 0.586–0.833), respectively. The combined model of GERAADA score and Surgeon’s Score yielded an AUC of up to 0.761 (95% CI: 0.638–0.884). CONCLUSIONS: Intuition certainly has a place alongside evidence-based medicine. The duet of intuition and statistics-based scoring systems allows us to make more accurate predictions, potentially resulting in more rational clinical decisions.