More than 80% of anesthesiologists have been involved in surgical catastrophes

Anesthesia & AnalgesiaMar 1 2012

More than 80 percent of anesthesiologists have been involved in a catastrophic event involving death or injury to a patient during surgery, suggests a survey study in the March issue of Anesthesia & Analgesia, official journal of the International Anesthesia Research Society (IARS).

Such surgical catastrophes can have significant and lasting effects on anesthesiologists and other professionals, who could benefit from time and support to recover from the incident, according to the new research, led by Dr Farnaz M. Gazoni of University of Virginia Health System, Charlotte. They write, "These emotional and potentially cognitive effects can have repercussions not only for the physician involved but also, conceivably, for patients subsequently cared for."

Lasting Impact of Catastrophic Events
The researchers sent a survey regarding surgical catastrophes—events leading to unanticipated death or injury of a patient—to a nationwide sample of anesthesiologists. Of 659 responders, 84 percent had been involved in a surgical catastrophe—an average of 4.4 events over an entire career.

Asked to recall their "most memorable" catastrophic event, more than 70 percent of respondents said they experienced guilt, anxiety, and reliving of the event. Most felt personally responsible for the death or injury of the patient—even if they considered the event to be unpreventable.

Nearly 90 percent of the anesthesiologists said it took some time to recover emotionally from the catastrophic event; nearly 20 percent said they had never fully recovered. Twelve percent even considered changing careers in the aftermath of the catastrophe.

Two-thirds of the anesthesiologists felt their ability to care for patients was compromised in the hours after the event. Yet nearly all had to carry on with their usual work schedule—only seven percent were given time off after the incident. Most respondents felt that some sort of formal debriefing session after the event would have been helpful.

Call for Changes to Prevent 'Second or Third Victims'
While previous research has shown that the death or injury of a patient is a major source of stress for doctors, the new study is the first to focus on surgical catastrophes involving U.S. anesthesiologists. "A perioperative catastrophe may have a profound and lasting emotional impact on the anesthesiologist involved and may affect his or her ability to provide patient care in the aftermath of such events," Dr Gazoni and coauthors conclude.

Surgical catastrophes may have additional victims as well, according to an editorial by Drs Timothy W. Martin of University of Arkansas for Medical Sciences, Little Rock, and Raymond C. Roy of Wake Forest University School of Medicine, Winston-Salem, N.C. As shown in the new study, such incidents can have a lasting emotional impact on anesthesiologists, making them the "second victim" of the event. In addition, if anesthesiologists are required to return to their usual duties immediately—despite feeling that their ability to care for patients is compromised—it raises the possibility that subsequent patients could become the "third victims."

The study suggests some "new imperatives" in the way health care organizations respond to catastrophic events, according to Drs Martin and Roy. They believe that anesthesiologists (and other professionals) should probably not be allowed to return to patient care duties immediately after being involved in a surgical catastrophe. The authors also suggest some type of formal mental health screening after the incident, as well as ongoing monitoring for signs of long-term psychological impairment.