Upper Gastrointestinal Unit, Department of Surgery, North Shore Hospital, Auckland, New Zealand.
Cancer and Chronic Conditions Research Group, Department of Public Health, University of Otago on Wellington Harbor, Wellington, New Zealand.
JAMA Surg. 2019 May 1;154(5):451-457. doi: 10.1001/jamasurg.2018.5640.
Patient complications occur in all areas of surgery, and managing them is an important part of surgical practice. Several investigations have examined whether surgeon health affects patient outcomes; however, to date, whether adverse patient outcomes affect surgeon well-being has not been comprehensively examined.
To examine how surgical complications in their patients affect the health of surgeons, in particular emotional outcomes, coping strategies, and support mechanisms.
A systematic literature review was conducted to identify studies evaluating how patient complications affect surgeons with the aim of determining emotional outcomes, coping strategies, and support mechanisms. Studies pertaining to burnout alone or not conducted in surgeons were excluded. The databases searched included MEDLINE, Embase, PubMed, Web of Science, and Google Scholar, with all literature available on these data sets until the search date of May 1, 2018; collected data were analyzed between May 2 and June 1, 2018. The reference lists of all included studies, as well as related review articles, were manually searched to identify further relevant studies. An inductive approach was used to identify common themes.
Nine case series or cross-sectional studies from the United Kingdom or North America were found (8518 unique participants), with 1 study in surgical trainees. Across all studies, surgeons were affected emotionally after complications, with adverse consequences in their professional and personal lives. Four themes were identified within the literature: the adverse emotional influence of complications (anxiety, guilt, sadness, shame, interference with professional and leisure activities) after intraoperative adverse events; coping mechanisms used by surgeons and trainees (limited discussion with colleagues, exercise, artistic or creative outlets, alcohol and substance abuse); institutional support mechanisms and barriers to support (clinical conferences, discussion with mentors, a perception that emotional distress would be perceived as a constitutional weakness); and the consequences of complications in future clinical practice (changes in practice, introduction of protocols, education of staff members, and participating in root-cause analysis).
This study's findings suggest that complications affect surgeons adversely across multiple domains. Further efforts are required at a personal, departmental, institutional, and organizational level to provide effective support. This review highlights that the psychological consequences of patient complications seem to be an important occupational health issue for surgeons.
患者并发症出现在外科的各个领域，对其进行管理是外科实践的重要组成部分。已有多项研究调查了外科医生的健康状况是否会影响患者的预后；然而，迄今为止，患者不良预后是否会影响外科医生的健康状况尚未得到全面研究。
调查外科医生的患者并发症如何影响其健康，特别是情绪结果、应对策略和支持机制。
系统地进行了文献回顾，以确定评估患者并发症如何影响外科医生的研究，目的是确定情绪结果、应对策略和支持机制。排除了仅涉及倦怠或非外科医生进行的研究。检索的数据库包括 MEDLINE、Embase、PubMed、Web of Science 和 Google Scholar，截至 2018 年 5 月 1 日，这些数据集中的所有文献都可检索；于 2018 年 5 月 2 日至 6 月 1 日之间分析收集的数据。还手动检索了所有纳入研究的参考文献以及相关的综述文章，以确定其他相关研究。使用归纳方法确定常见主题。
从英国或北美共找到 9 项病例系列或横断面研究（8518 名独特参与者），其中 1 项研究涉及外科实习医生。在所有研究中，术后并发症会使外科医生情绪受到影响，对其职业和个人生活造成不良后果。文献中确定了 4 个主题：手术期间发生不良事件后的并发症对情绪的不利影响（焦虑、内疚、悲伤、羞耻、专业和休闲活动的干扰）；外科医生和实习医生使用的应对机制（与同事的讨论有限、运动、艺术或创造性出口、酗酒和药物滥用）；机构支持机制和支持障碍（临床会议、与导师的讨论、一种认为情绪困扰会被视为体质弱点的看法）；以及并发症对未来临床实践的影响（改变实践、引入方案、员工教育和参与根本原因分析）。
本研究结果表明，并发症会在多个领域对外科医生产生不利影响。需要在个人、部门、机构和组织层面进一步努力，提供有效的支持。该综述强调，患者并发症的心理后果似乎是外科医生一个重要的职业健康问题。
