Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital and Harvard Medical School, Boston, MA.
Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital and Harvard Medical School, Boston, MA.
J Am Coll Surg. 2017 Jun;224(6):1048-1056. doi: 10.1016/j.jamcollsurg.2016.12.039. Epub 2017 Jan 16.
An intraoperative adverse event (iAE) is often directly attributable to the surgeon's technical error and/or suboptimal intraoperative judgment. We aimed to examine the psychological impact of iAEs on surgeons as well as the surgeons' attitude about iAE reporting.
We conducted a web-based cross-sectional survey of all surgeons at 3 major teaching hospitals of the same university. The 29-item questionnaire was developed using a systematic closed and open approach focused on assessing the surgeons' personal account of iAE incidence, emotional response to iAEs, available support systems, and perspective about the barriers to iAE reporting.
The response rate was 44.8% (n = 126). Mean age of respondents was 49 years, 77% were male, and 83% performed >150 procedures/year. During the last year, 32% recalled 1 iAE, 39% recalled 2 to 5 iAEs, and 9% recalled >6 iAEs. The emotional toll of iAEs was significant, with 84% of respondents reporting a combination of anxiety (66%), guilt (60%), sadness (52%), shame/embarrassment (42%), and anger (29%). Colleagues constituted the most helpful support system (42%) rather than friends or family; a few surgeons needed psychological therapy/counseling. As for reporting, 26% preferred not to see their individual iAE rates, and 38% wanted it reported in comparison with their aggregate colleagues' rate. The most common barriers to reporting iAEs were fear of litigation (50%), lack of a standardized reporting system (49%), and absence of a clear iAE definition (48%).
Intraoperative AEs occur often, have a significant negative impact on surgeons' well-being, and barriers to transparency are fear of litigation and absence of a well-defined reporting system. Efforts should be made to support surgeons and standardize reporting when iAEs occur.
术中不良事件（iAE）通常直接归因于外科医生的技术错误和/或术中判断不佳。我们旨在研究 iAE 对外科医生的心理影响以及外科医生对 iAE 报告的态度。
我们对同一所大学的 3 家主要教学医院的所有外科医生进行了基于网络的横断面调查。该 29 项问卷采用系统的封闭式和开放式方法制定，重点评估外科医生对 iAE 发生率的个人报告、对 iAE 的情绪反应、可用的支持系统以及对 iAE 报告障碍的看法。
应答率为 44.8%（n=126）。受访者的平均年龄为 49 岁，77%为男性，83%每年进行>150 次手术。在过去的一年中，32%的人回忆起 1 次 iAE，39%的人回忆起 2 到 5 次 iAE，9%的人回忆起>6 次 iAE。iAE 的情绪代价是巨大的，84%的受访者报告说同时出现焦虑（66%）、内疚（60%）、悲伤（52%）、羞耻/尴尬（42%）和愤怒（29%）。同事是最有帮助的支持系统（42%），而不是朋友或家人；少数外科医生需要心理治疗/咨询。至于报告，26%的人不希望看到自己的个人 iAE 率，而 38%的人希望与他们的同事总 iAE 率进行比较。报告 iAE 的最常见障碍是害怕诉讼（50%）、缺乏标准化报告系统（49%）和缺乏明确的 iAE 定义（48%）。
术中不良事件经常发生，对外科医生的健康有重大负面影响，阻碍透明度的因素是害怕诉讼和缺乏明确的报告系统。当发生 iAE 时，应努力支持外科医生并规范报告。
