Postoperative complications and their association with post-traumatic stress disorder in academic vascular surgeons

Postoperative complications are an inherent component of surgical practice. This study seeks to address their association with emotional responses of academic vascular surgeons.

An anonymous electronic survey was sent to all vascular surgery program directors in North America with a request to disseminate to their faculty. The survey captured data on demographics and practice type and used imbedded validated measures to determine emotional responses to postoperative complications and to assess coping mechanisms. Univariate analysis was performed to determine differences between those who reported at least partial symptoms of post-traumatic stress disorder (PTSD) following their worse major complication over the previous year and those who did not. Multivariable logistic regression analysis was performed for all covariates found significant on univariate analysis, and those deemed clinically relevant.

The survey was distributed to 267 faculty at 128 institutions in the United States and 10 institutions in Canada and completed by 65 participants (response rate, 32%). Twenty of 65 (31%) identified as female, and the total group had a mean age of 47 ± 10.2 years. Most respondents (43/65; 66%) reported a major complication within 3 months of the survey, with the majority of respondents (45/65; 69%) reporting the outcome of patient mortality. Of respondents, 20 of 65 (31%) demonstrated at least partial symptoms of PTSD in response to the worst complication from the previous year, with 12 of 65 (19%) meeting the clinical diagnosis of PTSD. Respondents in the PTSD group were more likely to criticize/blame themselves following the complication (P = .0028); less likely to identify the complication as "expected" (P = .048) or to believe causes of their complications were due to others/external factors; and more likely to identify as a female (55% vs 20%; P = .008). Regarding support following major complications, most respondents (57/65; 88%) desired the ability to discuss details of the case with a respected peer. The most common external pressure influencing their emotional responses to complications was maintaining reputation and a sense of honor (66%). Gender differences persisted on multivariate analysis (P = .016).

Emotional responses following major postoperative complications in vascular surgery are common and may pose a risk for PTSD. This may occur more commonly following complications that are unexpected or in cases in which the cause of the complication was due to a perceived or actual surgical mistake. The ubiquitous nature and severity of the emotional toll of major complications for vascular surgeons is poorly described and under-recognized. Gender-related differences may exist, and most surgeons desire a support network of respected peers with whom to discuss complications.