The Psychosocial Impact of Surgical Complications on the Operating Surgeon: A Scoping Review
Creators: name: Manjunath Siddaiah-Subramanya
name: To, Henry
name: Haige, Catherine
Publisher: name: figshare
Year: 2021
Subjects: subject: 110323 Surgery
subject: FOS: Clinical medicine
subject: FOS: Clinical medicine

description: Abstract<b>Background and Aim</b>Surgical complications are common, and their management is an integral part of surgical care. The impact on the surgeon, the “second victim” is significant, particularly in terms of psychological health. The aim of this review is to describe the nature of psychosocial consequences of surgical complications on the surgeons involved, and their typical responses to these.<b>Method</b>Following scoping review protocols, we set out to identify the evidence-base for psychosocial consequences on the operating surgeon, predominantly general surgeons, following surgical complications.<b>Results</b>This scoping review identified 19 articles, mainly survey and interview based (n=8), with all but one article from first world countries. Seven articles reported on negative emotions or depressive behavioural responses. All original studies reported on difficulty in coping (37.5%), and a range of behaviours (classified as constructive or destructive). There was little evidence for support structures or active interventions to aid the surgeon post complication.<b>Conclusion</b>The review suggests that the psychosocial impact, following a complication, is variable but affects every surgeon irrespective of the level of impact on the patient. The main variables differentiating impact are severity, and outcome of the complication and seniority of the surgeon. Reported emotions and behaviours were generally negative and persist across the surgeon’s journey towards recovery. Surgeons who manage stress well exhibit largely constructive behaviours and actively work to recover. Efforts to prevent complications, and to provide formal support and education are lacking. Identification of variables underpinning complications, and affected surgeons is paramount, as is the provision of services to support recovery.<b>Keywords</b>Surgeon, complication, Psycho, emotion, reaction, surgeon wellness (Term ‘Psycho’ allowed us to obtain broader results including psychological and psychosocial) IntroductionSurgical complications are common in the hospital system and estimates of their frequency range from 8-12% across the world [1-4]. Fortunately, not all incidents have a clinical impact due to robust hospital protocols and safety nets [5, 6]. Nonetheless, incidents leading to complications are a constant concern for operating surgeons, and although anticipated and discussed with patients, complications and their impact on surgeons are not commonly discussed with colleagues or team members or studied [7-10]. Surgery is interventional, and surgeons are particularly affected by any associated complications because of their direct involvement with the patient, whatever the outcome. Consequences for the surgeon, termed the “second victim” in this context, have been reported to have a broad personal impact [10, 11]. The effects may be physiological, physical, emotional, or behavioural. The origin and perpetuation of the cause and effect of these surgical complications has been shown to have an association with a number of factors such as long working hours, conflicts at home or with colleagues, administrative stressors, training responsibilities, and poor physical health of the surgeon [9, 12]. There are few reported reviews of the extent, root cause or needs analysis of these issues. Therefore, we aim to conduct a scoping review to understand the magnitude and nature of the psychosocial consequences of surgical complications for the operating surgeon along with coping mechanisms utilised. We contend this should be the first step in understanding the journey of a surgeon from the incident to their psychological recovery, with an ultimate aim to architect an approach to prevention, recognition, and support so that recommendations can be made to various training boards, hospital employers, colleges and policy makers.