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March 27, 2019

Potential Consequences of Patient Complications for Surgeon Well-being: A Systematic Review

Author Affiliations
  • 1Upper Gastrointestinal Unit, Department of Surgery, North Shore Hospital, Auckland, New Zealand
  • 2Cancer and Chronic Conditions Research Group, Department of Public Health, University of Otago on Wellington Harbor, Wellington, New Zealand
JAMA Surg. 2019;154(5):451-457. doi:10.1001/jamasurg.2018.5640
Key Points

Question  What role do patient complications play in surgeon well-being?

Findings  This systematic review of 9 studies (10 702 unique participants) demonstrated that the occurrence of patient complications adversely affected surgeons’ psychological well-being and their professional and personal lives.

Meaning  Results of this study suggest that patient complications adversely affect surgeons’ health, and departments, institutions, and professional organizations must acknowledge this and develop strategies to educate and support surgeons in managing this part of their professional lives.


Importance  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.

Objective  To examine how surgical complications in their patients affect the health of surgeons, in particular emotional outcomes, coping strategies, and support mechanisms.

Evidence Review  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.

Findings  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).

Conclusions and Relevance  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.

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    1 Comment for this article
    Institutional Betrayal of Surgeons with Complications
    Harald Aanning, MD | Non-Affiliated Retired Surgeon
    In my experience, surgeons confronted with a harmed patient, or a dead patient from a complication, often find themselves taking the fall when their hospital suddenly opts out of the "team" to circle its own wagons.

    Such institutional betrayal leaves a sensitive surgeon alone to cope with ethical challenges such as a falsified death certificate omitting the complication as a cause of death, a medical chart scrubbed of any complication mention, and a patient (or family) with bills to pay.