Surgeon Perceptions of Failure to Rescue After Surgery

Area of Science:

• Medical quality improvement
• Surgical education
• Patient safety

Background:

• Failure to rescue (FTR) is a critical indicator of surgical quality, defined as death after a potentially manageable complication.
• While clinical and systemic factors are known, surgeons' interpretations and the impact on learning are underexplored.

Purpose of the Study:

• To explore how surgeons interpret FTR events.
• To identify factors contributing to FTR from the surgeon's perspective.
• To inform improvements in surgical education and culture.

Main Methods:

• Qualitative study involving semistructured interviews with 14 board-certified surgeons in Switzerland and Austria.
• Surgeons had 5+ years of experience and direct involvement in FTR events.
• Analysis used constructivist grounded theory to identify themes.

Main Results:

• Surgeons felt "trapped in a flawed system" and faced "hierarchical barriers" hindering communication and decision-making.
• They viewed themselves as "imperfect heroes," balancing passion with vulnerability.
• FTR experiences, though difficult, aided clinical expertise, with surgeons sharing strategies for improvement.

Conclusions:

• Surgeon confidence and self-reliance, while vital, can impede timely complication recognition.
• Reducing hierarchical barriers and increasing peer support are crucial.
• Shifting from "heroic hubris" to collective learning can improve surgical culture and patient outcomes.