Uncertainty and chance in surgical practice: a narrative literature revision of navigating the labyrinth of uncertain outcomes

Abstract

Introduction: Surgery is a discipline that operates within an environment of inherent uncertainty, where chance and unpredictability directly influence processes and outcomes. This review seeks to explore the sources and impact of uncertainty in surgery and propose strategies for its effective management. Methods: A narrative literature review was conducted using databases such as PubMed, Scopus, and Web of Science, focusing on concepts of uncertainty, variability, decision-making, and patient safety in surgical contexts. The synthesis aims to identify applicable conceptual frameworks and tools. Results: Uncertainty in surgery manifests in three main domains: biological (unpredictable physiological response of the patient), technical (anatomical and skill variability), and cognitive (limitations in processing complex information). Chance influences the occurrence of rare but critical complications. Strategies such as checklists, simulation of adverse scenarios, peer review of cases, and the development of experiential clinical judgments have been shown to mitigate the negative effects of uncertainty. Conclusion: Uncertainty and chance are inherent and unavoidable elements of surgical practice. Rather than ignoring them, surgical systems must develop a "culture of uncertainty" that fosters clinical humility, preparedness for the unexpected, and adaptability. Integrating these strategies is crucial for advancing toward safer and more resilient surgery.