Human Factors and Quantitative Data: Diverging Perspectives on ICG use in Emergency Bowel Surgery -  A systematic literature review.

In 30 seconds

This systematic review examined how human factors shape interpretation of indocyanine green (ICG) fluorescence during emergency bowel surgery, comparing reported quantitative outcomes with qualitative accounts of decision-making. It included 31 original studies identified from 266 screened articles. ICG influenced surgical decisions in 302 of 308 cases, yet fluorescence findings and clinical actions diverged in 38.3% of cases. The review identified confirmation and anchoring biases, overconfidence, and reliance on ICG to support prior decisions, alongside systemic barriers such as limited interdisciplinary input and non-standardized interpretation.

Key findings

• ICG influenced surgical decision-making in 302 of 308 cases.
• Fluorescence findings and clinical actions were discrepant in 38.3% of cases.
• Reported cognitive patterns included confirmation and anchoring bias, overconfidence, and use of ICG to reinforce pre-established decisions.
• Systemic limitations included limited interdisciplinary input and absence of standardized interpretation protocols.

Why it matters

ICG provides information during high-stakes emergency surgery, but its interpretation is not independent of clinical judgment or operating-room context. The reported divergence between fluorescence and action highlights why technical efficacy alone may not ensure consistent decision-making. Recognizing cognitive and systemic influences is relevant to evaluating intraoperative findings and to efforts to improve interpretive consistency.

What to keep in mind

The review notes case-report bias and the absence of standardized interpretation protocols in the underlying literature.