Journal of evaluation in clinical practice · 2026
Very Important Person (VIP) Syndrome: Psychological Illusion or Real Surgical Risk? A Propensity Score-Matched Cohort Study of Robot-Assisted Radical Prostatectomy With a Surgeon Survey.
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Park Taeyoung, Lee Hyemi, Kim Tae Beom, Chung Kyung Jin, Kim Chang Hee, Kim Kwang Taek, Park Il Woo
Аннотация
RATIONALE, AIMS AND OBJECTIVES: Special treatment of very important persons (VIPs) is widely believed to cause deviation from standard care and worse outcomes, but has rarely been tested objectively, especially in surgery. We examined whether VIP status is associated with worse outcomes after robot-assisted radical prostatectomy and the burden surgeons report when operating on such patients.
METHOD: In a single-centre retrospective study, 75 patients flagged as VIP among 571 men undergoing robot-assisted radical prostatectomy for non-metastatic prostate cancer were matched 1:4 to 300 controls by a propensity score from eight covariates, with exact matching on surgeon (analytic cohort, 375). Perioperative outcomes, complications, and readmission were compared, and six surgeons completed an exploratory eight-item burden survey.
RESULTS: After matching, covariates were well balanced (all standardised mean differences below 0.10 except operative year, 0.130). Surgical and complication outcomes showed no difference (complications: risk difference +8.0 points, 95% confidence interval -2.0 to +18.0). The exception was inpatient antibiotic days, longer in VIPs by 0.87 days (95% confidence interval +0.17 to +1.57), though concentrated in one surgeon and non-significant once that surgeon was excluded (interaction p < 0.001). Surgeons reported higher cognitive strain and a greater defensive-prescribing impulse, yet their reported intent and actual prescribing correlated only weakly and non-significantly.
CONCLUSION: VIP status was not associated with worse objective outcomes, but a few surgeons prolonged antibiotics defensively without clear benefit, while their reported burden stayed high, dissociating perception from outcome. Maintaining standard, protocol-based care and antimicrobial stewardship for every patient is the safe and equitable response; the small sample limits precision.
METHOD: In a single-centre retrospective study, 75 patients flagged as VIP among 571 men undergoing robot-assisted radical prostatectomy for non-metastatic prostate cancer were matched 1:4 to 300 controls by a propensity score from eight covariates, with exact matching on surgeon (analytic cohort, 375). Perioperative outcomes, complications, and readmission were compared, and six surgeons completed an exploratory eight-item burden survey.
RESULTS: After matching, covariates were well balanced (all standardised mean differences below 0.10 except operative year, 0.130). Surgical and complication outcomes showed no difference (complications: risk difference +8.0 points, 95% confidence interval -2.0 to +18.0). The exception was inpatient antibiotic days, longer in VIPs by 0.87 days (95% confidence interval +0.17 to +1.57), though concentrated in one surgeon and non-significant once that surgeon was excluded (interaction p < 0.001). Surgeons reported higher cognitive strain and a greater defensive-prescribing impulse, yet their reported intent and actual prescribing correlated only weakly and non-significantly.
CONCLUSION: VIP status was not associated with worse objective outcomes, but a few surgeons prolonged antibiotics defensively without clear benefit, while their reported burden stayed high, dissociating perception from outcome. Maintaining standard, protocol-based care and antimicrobial stewardship for every patient is the safe and equitable response; the small sample limits precision.