The Surgeon as the Second Victim? Results of the Boston Intraoperative Adverse Events Surgeons’ Attitude (BISA) Study

Kelsey Han, Jordan D. Bohnen, Thomas Peponis, Myriam Martinez, Anirudh Nandan, Daniel D. Yeh, Jarone Lee, Marc Demoya, George Velmahos, Haytham M.A. Kaafarani

Research output: Contribution to journalArticlepeer-review

45 Scopus citations


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. Study Design 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.

Original languageEnglish (US)
Pages (from-to)1048-1056
Number of pages9
JournalJournal of the American College of Surgeons
Issue number6
StatePublished - Jun 2017
Externally publishedYes

ASJC Scopus subject areas

  • Surgery


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