Contingency in everyday surgical work

This paper concerns a qualitative study exploring the nature of surgical work with a group of 34 surgeons involved in treating urinary incontinence. Sources of surgical variation are identified from surgeons' own accounts of their work as well as observation of the selection of patients and operative procedures, and the operative process itself. A typology of contingency, consisting of three categories of contingency (case, surgeon and external), was found in this area of everyday surgical work. In developing this typology, theoretical and philosophical ideas about habitus and disposition, and practical and technical knowledge, are considered and extended to help to understand the nature of surgical practice. These ideas may also be useful in explaining some of the apparent tensions between evidence-based surgery and everyday surgical work.