Surgeons Are Often Profoundly and Emotionally Affected By Surgical Complications

NewsBot · Nov 15, 2013

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Study Shows Surgeons Are Often Profoundly and Emotionally Affected By Surgical Complications

Many surgeons are seriously affected on an emotional level by major surgical complications, and they often feel that institutional support is inadequate. Those are among the conclusions of a small study published recently in the BJS (British Journal of Surgery). The findings provide valuable insights into the factors that affect surgeons’ reactions to surgical complications and how surgeons could be better supported in their aftermath.

The operating room is one of the highest risk areas for serious complications with potentially profound consequences for patients and healthcare professionals, but little is known about the response of surgeons to serious complications or how best to support staff following such events. Recent research indicates that surgeons who reported a surgical error in recent months are more likely to have a lower quality of life and symptoms of burnout and depression. Such effects are important for surgeons and their families as well as for their patients because high levels of stress may negatively affect a surgeon’s clinical performance and compromise patient safety.

To explore the impact of complications on surgeons, Anna Pinto, PhD, of the Imperial College London, St Mary's Campus, and her colleagues examined how surgeons are affected by such incidents on a personal and professional level, which factors affect their reactions, how they cope with their consequences, and how they perceive support at their institutions.

The researchers conducted individual interviews with 27 general and vascular surgeons from two large National Health Service organizations in London. The interviews revealed that surgeons are seriously affected by major surgical complications, particularly those for which they feel responsible. All participants referred to at least one case in their practice where a complication affected them significantly on a personal and professional level. Factors that determined their reactions included the complications’ preventability, surgeons’ personalities and experience, patients’ outcomes and reactions, colleagues’ reactions, and the institutions’ culture.

Surgeons generally described institutional support as inadequate. Suggestions for approaches to support surgeons in managing the impact of complications included: better mentoring, teamwork approaches in surgical practice, blame-free forums for the discussion of complications, and supports aimed at the human aspects of complications.

“This study contributes to an understanding of the wider impact of surgical complications on surgeons’ personal and professional wellbeing,” said Dr. Pinto. “Given the potential impact on patients as well as on surgeons, additional support and mentoring should be seriously considered by the surgical community and by those involved in the management of surgical services. Further research is needed on how to implement support structures that meet the needs of the small number of surgeons who are affected to the point that personal life and clinical practice deteriorate.”
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NewsBot · Nov 15, 2013

Surgical complications and their implications for surgeons' well-being.
A. Pinto, O. Faiz, C. Bicknell, C. Vincent.
British Journal of Surgery, 2013; 100 (13): 1748

Background
Healthcare professionals can be seriously affected when they are involved in major clinical incidents. The impact of such incidents on staff is of particular relevance to surgery, as the operating room is one of the highest-risk areas for serious complications. This qualitative study aimed to assess the personal and professional impact of surgical complications on surgeons.

Methods
This single time point study involved semistructured, individual interviews with general and vascular surgeons, consultants and senior registrars from two National Health Service organizations in London, UK.

Results
Twenty-seven surgeons participated. Many were seriously affected by major surgical complications. Surgeons' practice was also often affected, not always in the best interest of their patients. The surgeons' reactions depended on the preventability of the complications, their personality and experience, patient outcomes and patients' reactions, as well as colleagues' reactions and the culture of the institution. Discussing complications, deconstructing the incidents and rationalizing were the most commonly quoted coping mechanisms. Institutional support was generally described as inadequate, and the participants often reported the existence of strong institutional blame cultures. Suggestions for supporting surgeons in managing the personal impact of complications included better mentoring, teamwork approaches, blame-free opportunities for the discussion of complications, and structures aimed at the human aspects of complications.

Conclusion
Those involved in the management of surgical services need to consider how to improve support for surgeons in the aftermath of major surgical incidents.
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