title: The Surgeon as the Second Victim? Results of the Boston Intraoperative Adverse Events Surgeons' Attitude (BISA) Study.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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%).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital and Harvard Medical School, Boston, MA.
authors.forename: Kelsey
authors.initials: K
authors.lastname: Han
authors.affiliation: Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital and Harvard Medical School, Boston, MA.
authors.forename: Jordan D
authors.initials: JD
authors.lastname: Bohnen
authors.affiliation: Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital and Harvard Medical School, Boston, MA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Peponis
authors.affiliation: Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital and Harvard Medical School, Boston, MA.
authors.forename: Myriam
authors.initials: M
authors.lastname: Martinez
authors.affiliation: Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital and Harvard Medical School, Boston, MA.
authors.forename: Anirudh
authors.initials: A
authors.lastname: Nandan
authors.affiliation: Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital and Harvard Medical School, Boston, MA.
authors.forename: Daniel D
authors.initials: DD
authors.lastname: Yeh
authors.affiliation: Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital and Harvard Medical School, Boston, MA.
authors.forename: Jarone
authors.initials: J
authors.lastname: Lee
authors.affiliation: Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital and Harvard Medical School, Boston, MA.
authors.forename: Marc
authors.initials: M
authors.lastname: Demoya
authors.affiliation: Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital and Harvard Medical School, Boston, MA.
authors.forename: George
authors.initials: G
authors.lastname: Velmahos
authors.affiliation: Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital and Harvard Medical School, Boston, MA. Electronic address: hkaafarani@mgh.harvard.edu.
authors.forename: Haytham M A
authors.initials: HMA
authors.lastname: Kaafarani
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D001900:Boston; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007431:Intraoperative Complications; D008297:Male; D019300:Medical Errors; D008875:Middle Aged; D012308:Risk Management; D057566:Self Report; D013043:Specialties, Surgical; D066231:Surgeons / Q000523:psychology*; D055815:Young Adult