Patients and their families are the immediate victims when interoperative adverse events occur; however, the psychological and emotional suffering associated with these outcomes can make second victims of the surgeon and other participants of the care team.

Panelists discussed key topics related to Second Victim Syndrome during a session yesterday afternoon, including post-traumatic stress disorder among surgeons, second victim support strategies, and employee assistance programs.  

Haytham M. Kaafarani, MD, MPH, FACS, session co-moderator, described a personal experience with Second Victim Syndrome that occurred after he performed several operations to treat the injuries of a patient who had been impaled by a forklift. Unfortunately, the patient died from a postoperative soft tissue infection, which caused Dr. Kaafarani to doubt his clinical judgment.

According to a study of Boston physicians, coauthored by Dr. Kaafarani and published in the Journal of the American College of Surgeons (JACS) in 2017, “the emotional toll of interoperative adverse events was significant” among respondents, with 84.1% reporting a combination of anxiety, guilt, sadness, shame/embarrassment or anger.

“Most striking were the pages-upon-pages of free-text comments submitted voluntarily by our colleagues, as if finally given permission to discuss their feelings, so often left unsaid in our stoic surgical culture,” Dr. Kaafarani said. “As one surgeon stated, ‘We all hide our grief, suffer in silence. The pain can be close to debilitating.’”

The effects of Second Victim Syndrome may result in increased job-related stress, according to Dr. Kaafarani, including anxiety regarding potential future errors, diminished confidence, and reduced job satisfaction.

Citing another study published in JACS from 2020, he described the design and impact of a surgery-specific, second victim peer support program. After stakeholders conducted a systemic review of the literature published on the topic, they developed the program, which included training peer supporters, determining systemic identification of major adverse events, and designing an intervention plan.  

“Peer support programs, especially surgeon-specific peer support programs, are powerful in their ability to support colleagues in times of need,” noted Dr. Kaafarani. “The value of these programs comes from four essential attributes: the ability of the peer supporter to say, ‘I’ve been there, I know how it feels;’ an opt-out design that normalizes reaching out to surgeons rather than placing the burden on them to call for help; listening without trying to fix the situation; and placing the program under quality assurance (QA) but conceptually separating it from QA and root cause analysis.”

“We need, as surgeons, to nurture a culture that supports second victims as much as it promotes the safety of our patients,” he added.

PS117: Patient Injury and Death: The Surgeon as the Second Victim is available for on-demand viewing for both virtual and in-person registrants.