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Surgical Catastrophes and Anesthesiology

Author Information (click to view)

Marcel E. Durieux, MD, PhD

Professor of Anesthesiology and Neurological Surgery
University of Virginia Health System

Marcel E. Durieux, MD, PhD, has indicated to Physician’s Weekly that he has worked as a consultant for Durect Corporation and Eisai, and has received grants/research aid from the American Heart Association, the NIH, and the American Society of Regional Anesthesia and Pain Medicine.

 

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Marcel E. Durieux, MD, PhD (click to view)

Marcel E. Durieux, MD, PhD

Professor of Anesthesiology and Neurological Surgery
University of Virginia Health System

Marcel E. Durieux, MD, PhD, has indicated to Physician’s Weekly that he has worked as a consultant for Durect Corporation and Eisai, and has received grants/research aid from the American Heart Association, the NIH, and the American Society of Regional Anesthesia and Pain Medicine.

 

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The lasting impact of catastrophic events can turn anesthesiologists into a “second victim” of the incident. Healthcare organizations should establish well-defined responses to these situations.
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Most anesthesiologists will experience at least one perioperative catastrophe over the course of their careers. These events may have a profound and lasting emotional impact on anesthesiologists and may affect their ability to provide patient care in the aftermath of the incident (see article from guest blogger, Skeptical Scalpel, Complications & Collateral Damage).

In an effort to more closely examine the impact of perioperative catastrophes on anesthesiologists, my colleagues and I conducted a survey that was published in Anesthesia & Analgesia. We sent a questionnaire to 1,200 randomly selected members of the American Society of Anesthesiologists who were practicing in the United States. Among the 659 anesthesiologists who completed the survey, 84% had been involved in at least one unanticipated death or serious injury of a perioperative patient during their career.

Catastrophic Events Have a Lasting Impact

When we asked anesthesiologists to recall their most memorable catastrophic event, more than 70% reported that they experienced guilt and anxiety and reliving the event. Most felt personally responsible for the death or injury, even if they considered the event to be unpreventable. The vast majority (88%) required time to recover emotionally from the catastrophe, and 19% acknowledged having never fully recovered. Another 12% even considered changing careers in the aftermath of the catastrophe.

In addition, about two-thirds of the anesthesiologists reported feeling that their ability to care for patients was compromised in the first 4 hours after the event. However, nearly all respondents reported that they carried on with their usual work schedule after the incident occurred. In fact, only 7% were given time off. Our results clearly demonstrate that surgical catastrophes seriously affect providers and that efforts are needed to better address and manage the emotional impact these events have on anesthesiologists.

Important Implications for Healthcare Organizations

Another key finding from our study is that most respondents believed that some type of formal debriefing session after they experienced the surgical catastrophe would have been helpful. The lasting impact of these events can turn anesthesiologists into a “second victim” of the incident. Requiring anesthesiologists to return to their usual duties immediately after surgical catastrophes raises the possibility that even more patients could be harmed if indeed their ability to function is compromised.

Healthcare organizations should establish well-defined responses to catastrophic events. It’s important to institute specific policies and procedures for anesthesiologists (and other healthcare providers who may experience perioperative catastrophes) that outline plans for assisting those who experience these events. In most cases, anesthesiologists should probably not be allowed to return to patient care duties immediately after being involved in a surgical catastrophe. Offering formal mental health screenings should be considered after these incidents, and it should be realized that anesthesiologists who have been involved in a perioperative catastrophe may experience long-term psychological problems.

Are you haunted by your patient “graveyard”?

Read guest blogger, Skeptical Scalpel’s post, “Complications & Collateral Damage.”

 

Readings & Resources (click to view)

Gazoni FM, Amato PE, Malik ZM, Durieux ME. The impact of perioperative catastrophes on anesthesiologists: results of a national survey. Anesth Analg. 2012;114:596-603. Abstract available at: http://www.anesthesia-analgesia.org/content/114/3/596.abstract.

Gazoni FM, Durieux ME, Wells L. Life after death: the aftermath of perioperative catastrophes. Anesth Analg. 2008;107:591-600.

Gaba DM. Human error in anesthetic mishaps. Int Anesthesiol Clin. 1989;27:137-147.

Martin TW, Roy RC. Cause for pause after a perioperative catastrophe: one, two, or three victims? Anesth Analg. 2012;114:485-487.

Eichhorn J. Organized response to major anesthesia accident will help limit damage. APSF Newsl. 2006;21:11-13.

Goldstone AR, Callaghan CJ, Mackay J, et al. Should surgeons take a break after an intraoperative death? Attitude survey and outcome evaluation. BMJ. 2004;328:379.

Manser T, Staender S. Aftermath of an adverse event: supporting health care professionals to meet patient expectations through open disclosure. Acta Anaesthesiol Scand. 2005;49:728-734.

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