LAUSR

INTRODUCTION Pediatric neurosurgery is a sub-specialty of medicine that is responsible for diagnosing, managing, and treating neurological disease in children with the use of surgery. Good intraoperative decisions making is critical to ensuring patient safety, yet almost nothing is known about what factors play a role in intraoperative decisions. As such, the purpose of this paper was to explore the factors that influence intraoperative decisions when pediatric neurosurgeons encounter something unexpected or uncertain during surgery. METHODS The study utilized the Grounded Theory method of data collection and analysis. Twenty-six pediatric neurosurgeons from 12 countries around the world were interviewed between June-October 2020 about the factors that go into making intraoperative decisions. Data was analyzed line by line and constant comparison was used to examine relationships within, and across codes and categories. RESULTS Pediatric neurosurgeons reflected on six factors while operating in order to come to a decision about how to proceed when they encountered an uncertainty or complication. The study findings resulted in a conceptual model that describes how concrete data including biological and technological factors and contextual data including emotional/relational factors, surgeon factors, and cultural factors influence risk assessment when making an intraoperative decision during surgery. CONCLUSIONS The findings from this research can be used for training and educating surgeons about intraoperative decision-making processes. Pedagogical modules can be developed that includes training sessions on factors that may implicitly and explicitly influence thinking processes during an operation. Surgeons may also benefit from having open discussions with surgical colleagues about the rich, emotional, intellectual scope of the work that they do with all the challenges that these relationships can bring into decision-making in the operating room.