OBJECTIVES: Surgeons act as key decision makers in the selection of surgery to offer to the patient. The surgeons’ decision is affected by their preferences. Given the variety of available surgical methods, it is crucial to understand surgeons’ surgical preferences. This study took radical prostatectomy (RP) as an example to evaluate surgeons’ surgical preferences.

METHODS: 221 urologists performing RP at 90 hospitals in 26 provinces across China completed an online discrete choice experiment survey in which respondents chose between 10 choice pairs of hypothetical surgeries for several questions under separate scenarios of patients’ economic status being ‘well-off’ or ‘less well-off’. The questions described surgeries with 5 attributes: continence recovery rate at 3 months after surgery (as a surrogate for surgery effectiveness), surgery cost, extent of surgeon fatigue during the surgery, additional incentives for physicians, and surgical device availability. These attributes were determined by literature review and semi-structured interviews. A mixed logit model was used.

RESULTS: Data for 200 urologists who passed the consistency test were analyzed. Surgeons’ choices indicated that when patients had ‘well-off’ economic status, surgery effectiveness impacted most on the surgeons’ preferences, followed by fatigue during the surgery, device availability, and incentives. Concerning patients with ‘less well-off’ economic status, surgeons considered surgery cost to be the most important factor, and surgery effectiveness to be the next important. There were no obvious differences in weighted importance between the remaining attributes.

CONCLUSIONS: Regardless of the patients’ economic status, surgeons placed great importance on surgery effectiveness. When the patient’s economic status was ‘less well-off’, surgeons paid extra attention to surgery cost. The above results reflect the altruism of surgeons as patients’ agents. Additionally, our study found that surgeons also considered the impact of the surgery on themselves, including fatigue during the surgery, and incentives, and device availability.